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General NPI Number Information
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NPI Number | 1548225402
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Entity Type | Organization
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Legal Business Name | WESTERN ORTHOPAEDIC & SPORTS MEDICINE CONSULTANTS, P.A.
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 490 S MAPLE ST
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City | WACONIA
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State | MN
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Zip | 55387-1760
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Country | US
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Telephone | 952-442-6525
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Fax | 952-442-6526
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Provider Business Mailing Address
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Address Line | 7261 OHMS LN
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City | EDINA
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State | MN
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Zip | 55439-2148
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Country | US
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Telephone | 952-442-6525
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Fax | 952-442-6526
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Authorized Official
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Title or Position | PARTNER
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Name | DR. D DANIEL ROTENBERG
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Credential | M.D.
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Telephone | 952-442-6525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1464
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License Number State | MN
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