Healthcare Provider Details

I. General information

NPI: 1366971863
Provider Name (Legal Business Name): NATHANIEL RAWICKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 HENNESSY BLVD STE 200
BATON ROUGE LA
70808-4794
US

IV. Provider business mailing address

8100 W 78TH ST STE 230
EDINA MN
55439-2570
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-0050
  • Fax: 225-766-1499
Mailing address:
  • Phone: 952-946-9777
  • Fax: 952-946-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number70864
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number336295
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: