Healthcare Provider Details

I. General information

NPI: 1013053982
Provider Name (Legal Business Name): MICHELLE NICOLE RHEAULT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 S 7TH ST PEDIATRIC SPECIALTY CARE
MINNEAPOLIS MN
55454-1404
US

IV. Provider business mailing address

720 WASHINGTON AVE SE UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55414
US

V. Phone/Fax

Practice location:
  • Phone: 612-365-6777
  • Fax: 612-624-1446
Mailing address:
  • Phone: 612-884-0649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number242353
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number44250
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: