Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 57.009909 | OH |
N | 111NI0900X | Internist | 57.009909 | OH |
N | 207RC0000X | Internist - Cardiovascular Disease | 21226 | MN |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 23999 | MN |
NPI | 1144499187 |
---|---|
Provider Name | Dr. Henri Roukoz |
First Address | Minneapolis, MN 55455-0341 |
Second Address | Minneapolis, MN 55455-4800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2008 |
Last Update Date | 17/08/2017 |