MEDICARE: JOHN F ROTILIE 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
1	207R00000X	Internal Medicine Physician	25080	MN

General Provider Information

NPI Number	:	1598722464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN F ROTILIE MD

Provider Business Mailing Address
First Line	:	2300 SAINT CLAIR AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-1137
Country	:	US
Telephone Number	:	651-261-7764
Fax Number	:	651-291-0957

Provider Business Practice Location Address
First Line	:	2300 SAINT CLAIR AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-1137
Country	:	US
Telephone Number	:	651-261-7764
Fax Number	:	651-291-0957

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	05/20/2025

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