MEDICARE: ROTILIE, TOMAN, MCRAITH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	1584	MN

General Provider Information

NPI Number	:	1013053339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROTILIE, TOMAN, MCRAITH, LLC

Provider Business Mailing Address
First Line	:	2300 SAINT CLAIR AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-1137
Country	:	US
Telephone Number	:	651-291-1269
Fax Number	:	651-291-0957

Provider Business Practice Location Address
First Line	:	2300 SAINT CLAIR AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-1137
Country	:	US
Telephone Number	:	651-291-1269
Fax Number	:	651-291-0957

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN FRANCIS ROTILIE
Credential	:	M.D.
Telephone Number	:	651-219-1269

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	01/20/2010

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