Basic Information
| Provider Information | |||||||||
| NPI: | 1437265295 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DWORAK | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6465 WAYZATA BLVD | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554261728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525125600 | ||||||||
| FaxNumber: | 9525125650 | ||||||||
| Practice Location | |||||||||
| Address1: | 7373 FRANCE AVE S | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554354534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528320076 | ||||||||
| FaxNumber: | 9528329881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 07/10/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 25845 | MN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 55A72DW | 01 | BLUE CROSS BLUE SHIELD | OTHER | 82193900 | 01 | WISC MEDICAID | OTHER | 969990824019 | 01 | PREFERREDONE | OTHER | 925856 | 01 | MEDICA | OTHER | HP13209 | 01 | HEALTHPARNERS | OTHER |