Healthcare Provider Details

I. General information

NPI: 1174507925
Provider Name (Legal Business Name): EDWARD LEE ROSENBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E MAIN ST CUYUNA REGIONAL MEDICAL CENTER
CROSBY MN
56441-1645
US

IV. Provider business mailing address

320 E MAIN ST CUYUNA REGIONAL MEDICAL CENTER
CROSBY MN
56441
US

V. Phone/Fax

Practice location:
  • Phone: 218-546-7000
  • Fax: 218-545-4456
Mailing address:
  • Phone: 218-546-7000
  • Fax: 218-545-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23632
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: