Healthcare Provider Details

I. General information

NPI: 1497845861
Provider Name (Legal Business Name): ROBERT ARTHUR KRATZKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 HARVARD ST SE MASONIC CANCER CENTER, FIRST FLOOR, SUITE M100
MINNEAPOLIS MN
55455-0362
US

IV. Provider business mailing address

420 DELAWARE ST SE UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-5411
  • Fax:
Mailing address:
  • Phone: 612-625-5411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number40486
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: