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General NPI Number Information
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NPI Number | 1255573358
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Entity Type | Organization
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Legal Business Name | ROBERT J SEVENICH M.D.,J.D.,P.A.
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Dates
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Enumeration Date | 04/03/2009
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 1714 HOWARD ST N
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City | MAPLEWOOD
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State | MN
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Zip | 55109-4842
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Country | US
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Telephone | 612-509-5522
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Fax | 651-414-0279
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Provider Business Mailing Address
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Address Line | 855 VILLAGE CENTER DR STE 181
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City | NORTH OAKS
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State | MN
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Zip | 55127-3016
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Country | US
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Telephone | 651-444-8512
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Fax | 651-414-0279
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RACHEL POLSKI
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Credential |
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Telephone | 651-444-8512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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