Healthcare Provider Details

I. General information

NPI: 1104403641
Provider Name (Legal Business Name): REBECCA FRIBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA GROVE MD

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WEST AVE S
LA CROSSE WI
54601-8806
US

IV. Provider business mailing address

PO BOX 860912
MINNEAPOLIS MN
55486-0912
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-0940
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number31717
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number103876
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number71948
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: