Provider Demographics
NPI:1174541247
Name:WANNER, CHRISTOPHER ARNOLD (MD,)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ARNOLD
Last Name:WANNER
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 1ST ST
Mailing Address - Street 2:PO BOX 660
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267-1408
Mailing Address - Country:US
Mailing Address - Phone:320-589-1313
Mailing Address - Fax:320-589-3533
Practice Address - Street 1:400 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1408
Practice Address - Country:US
Practice Address - Phone:320-589-1313
Practice Address - Fax:320-589-3533
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN839625600Medicaid
WI34812700Medicaid
MN839625600Medicaid
H08429Medicare UPIN