Richard Wahlstrom, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

21093 Issued in MN

Practice address

2500 Sheridan Ave S
Minneapolis, MN 55405-2342

Phone

(612) 377-7863

Fax

(612) 374-1355

NPI assigned

Dec 22, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250726400000",
    "number": "1356328181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 SHERIDAN AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554052342",
            "telephone_number": "612-377-7863",
            "fax_number": "612-374-1355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 SHERIDAN AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554052342",
            "telephone_number": "612-377-7863",
            "fax_number": "612-374-1355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHLSTROM",
        "first_name": "RICHARD",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-22",
        "last_updated": "2009-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "21093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marcia Wahl, RN
• Peter Wahl, DNP
• Sharon Wahl, CCNS
• Sophia Wahl
• Ronald Bruce Wahlberg, MD
• Karen Judith Wahmanholm, MD
• David C Wahoff, MD
• Gerald Wahome
• Monica A Wainio, PT
• Zeinab Hassan Wais

• Internal Medicine Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Internal Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.