Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 69877 | WI |
N | 111NI0900X | Internist | 69877 | WI |
Y | 207RH0002X | Hospice and Palliative Medicine | PT17670 | ND |
NPI | 1093160806 |
---|---|
Provider Name | Mark D Rostad |
First Address | Fargo, ND 58103-4940 |
Second Address | Fargo, ND 58103-6132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2016 |
Last Update Date | 09/08/2021 |