Healthcare Provider Details

I. General information

NPI: 1356361489
Provider Name (Legal Business Name): SETH ROSENBAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 LYNDALE AVE S SUITE 232
BLOOMINGTON MN
55420-5614
US

IV. Provider business mailing address

10800 LYNDALE AVE S SUITE 232
BLOOMINGTON MN
55420-5614
US

V. Phone/Fax

Practice location:
  • Phone: 952-346-9523
  • Fax: 952-346-9531
Mailing address:
  • Phone: 952-346-9523
  • Fax: 952-346-9531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number23776
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: