Healthcare Provider Details

I. General information

NPI: 1003504036
Provider Name (Legal Business Name): ROSS RYBAKOWICZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE STREET SE MMC 195
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

420 DELAWARE STREET SE MMC 195
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-6483
  • Fax:
Mailing address:
  • Phone: 612-625-6483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number82553
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: