MEDICARE: JAMES HERMAN RAKOW AT

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	2255A2300X	Athletic Trainer	1165	MN

General Provider Information

NPI Number	:	1154349918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES HERMAN RAKOW AT

Provider Business Mailing Address
First Line	:	6465 WAYZATA BLVD
Second Line	:	SUITE 900
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-1728
Country	:	US
Telephone Number	:	952-512-5600
Fax Number	:	952-512-5650

Provider Business Practice Location Address
First Line	:	775 PRAIRIE CENTER DR
Second Line	:	SUITE 250
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7314
Country	:	US
Telephone Number	:	952-944-2519
Fax Number	:	952-944-0460

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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