Healthcare Provider Details

I. General information

NPI: 1811420466
Provider Name (Legal Business Name): MICHAELA ROKOSZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 PARKLAWN AVE STE 120
EDINA MN
55435-5660
US

IV. Provider business mailing address

3955 PARKLAWN AVE STE 120
EDINA MN
55435-5660
US

V. Phone/Fax

Practice location:
  • Phone: 952-278-7000
  • Fax: 952-898-5914
Mailing address:
  • Phone: 952-278-7000
  • Fax: 952-898-5914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number67013
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number67013
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: