Healthcare Provider Details

I. General information

NPI: 1235134354
Provider Name (Legal Business Name): PATRICK MICHAEL ROCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 E 24TH ST
MINNEAPOLIS MN
55404-3975
US

IV. Provider business mailing address

8996 TEWSBURY GATE
MAPLE GROVE MN
55311-1126
US

V. Phone/Fax

Practice location:
  • Phone: 612-721-9856
  • Fax: 612-721-2904
Mailing address:
  • Phone: 612-721-9856
  • Fax: 612-721-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38652
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: