Active NPI
Yanislav B Wolfson, MD
- Family Medicine Physician
- Woodbury, MN
National Provider Identifier
1811951445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 39894
- Practice address
- 8675 Valley Creek Rd
Woodbury, MN 55125-2337 - Phone
- (651) 241-3000
- NPI assigned
- Apr 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 39894 | MN | Primary |
Addresses
Primary practice location
8675 Valley Creek Rd
Woodbury, MN 55125-2337
Mailing address
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 824316600 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39894 | MN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320710400000",
"number": "1811951445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2925 CHICAGO AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554071321",
"telephone_number": "612-262-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8675 VALLEY CREEK RD",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551252337",
"telephone_number": "651-241-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLFSON",
"first_name": "YANISLAV",
"middle_name": "B",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-12",
"last_updated": "2011-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "39894",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "824316600",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.