Healthcare Provider Details

I. General information

NPI: 1194817072
Provider Name (Legal Business Name): ROBERT D WINSTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 COON RAPIDS BLVD SUITE 311
COON RAPIDS MN
55433
US

IV. Provider business mailing address

3435 WEST BROADWAY SUITE 1065
ROBBINSDALE MN
55422
US

V. Phone/Fax

Practice location:
  • Phone: 763-236-9090
  • Fax: 763-236-9089
Mailing address:
  • Phone: 763-520-1137
  • Fax: 763-520-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number33849
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: