Healthcare Provider Details

I. General information

NPI: 1972935583
Provider Name (Legal Business Name): ROBERT LEE MARCACCINI MD, PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 12TH ST N STE 100
SAINT CLOUD MN
56303-2253
US

IV. Provider business mailing address

1200 6TH AVE N
SAINT CLOUD MN
56303-2735
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-7257
  • Fax: 320-251-2938
Mailing address:
  • Phone: 320-251-2700
  • Fax: 320-656-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA195410
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number121293
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number76540
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: