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NPI Code Detail

MEDICARE: DR. ROGER AVILES MD

MEDICARE: DR. ROGER AVILES MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician44640MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053359976
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROGER AVILES MD
Provider Business Mailing Address
First Line : 4008 GRIMES AVE S
Second Line :
City : EDINA
State : MN
Zip : 55416-5060
Country : US
Telephone Number : 612-308-2319
Fax Number :
Provider Business Practice Location Address
First Line : 3955 PARKLAWN AVE
Second Line :
City : EDINA
State : MN
Zip : 55435-5655
Country : US
Telephone Number : 953-831-4454
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2006
Last Update Date : 03/17/2018

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Directions to “ DR. ROGER AVILES MD” Practice Location

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