Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 54556 | MN |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 54556 | MN |
NPI | 1033352307 |
---|---|
Provider Name | Thomas Pease Pittelkow |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2009 |
Last Update Date | 04/08/2020 |