Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 16759 | MN |
NPI | 1518116797 |
---|---|
Provider Name | Richard G Vandellen |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55902-3245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2008 |
Last Update Date | 12/09/2008 |