=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518933985
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL CHRISTIAN RONDESTVEDT MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2006
-----------------------------------------------------
Last Update Date | 07/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5200 FAIRVIEW BLVD
-----------------------------------------------------
City | WYOMING
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55092-8013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-982-7300
-----------------------------------------------------
Fax | 651-982-7301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | UNITY HOSPICE AND PALLIATIVE CARE OF SOUTHERN WISCONSIN 7633 GRANSER WAY, SUITE 102
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-515-5300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 37224
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207QH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 37224
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 74526-20
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------