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General NPI Number Information
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NPI Number | 1043879901
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Entity Type | Organization
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Legal Business Name | ROCKET SURGERY, LLC
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 6565 FRANCE AVE S STE 350
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City | EDINA
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State | MN
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Zip | 55435-2159
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Country | US
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Telephone | 952-999-9049
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Fax | 952-999-4081
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Provider Business Mailing Address
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Address Line | 11407 CREEKRIDGE DR
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City | EDEN PRAIRIE
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State | MN
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Zip | 55347-4311
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Country | US
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Telephone | 612-389-1093
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Fax |
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Authorized Official
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Title or Position | OWNER / CEO
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Name | DR. DEBORAH MICHELLE NOWAK
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Credential | MD
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Telephone | 612-389-1093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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