Healthcare Provider Details

I. General information

NPI: 1518933985
Provider Name (Legal Business Name): PAUL CHRISTIAN RONDESTVEDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/03/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 FAIRVIEW BLVD
WYOMING MN
55092-8013
US

IV. Provider business mailing address

UNITY HOSPICE AND PALLIATIVE CARE OF SOUTHERN WISCONSIN 7633 GRANSER WAY, SUITE 102
MADISON WI
53719
US

V. Phone/Fax

Practice location:
  • Phone: 651-982-7300
  • Fax: 651-982-7301
Mailing address:
  • Phone: 608-515-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37224
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number37224
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number74526-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: