1881767648 NPI number — ROBERT H ROSENBERG MD

Table of content: ROBERT H ROSENBERG MD (NPI 1881767648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881767648 NPI number — ROBERT H ROSENBERG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENBERG
Provider First Name:
ROBERT
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881767648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7373 FRANCE AVENUE S
Provider Second Line Business Mailing Address:
STE 302
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-4538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-896-3166
Provider Business Mailing Address Fax Number:
952-896-9853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7373 FRANCE AVENUE S
Provider Second Line Business Practice Location Address:
STE 302
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-4538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-896-3166
Provider Business Practice Location Address Fax Number:
952-896-9853
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  20409 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000017 . This is a "MEDICA PRIMARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: XX1410822003 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1001172 . This is a "MEDICA CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040003036 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20967 . This is a "ARAZ AMERICAN PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP14277 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1149620669 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14925RO . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20409 . This is a "LICENSE #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6166768300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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