Healthcare Provider Details

I. General information

NPI: 1528011269
Provider Name (Legal Business Name): DREW A ROSIELLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE ST SE MAYO BUILDING B344 MMC 603
MINNEAPOLIS MN
55455-0341
US

IV. Provider business mailing address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-3671
  • Fax: 612-273-4891
Mailing address:
  • Phone: 612-672-6362
  • Fax: 612-273-3891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number47733
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number52873
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: