Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 37224 | MN |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 37224 | MN |
NPI | 1518933985 |
---|---|
Provider Name | Paul Christian Rondestvedt |
First Address | Bloomington, MN 55437-1050 |
Second Address | Wyoming, MN 55092-8013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 13/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G30132 | (02) | MN |