MEDICARE: INFECTIOUS DISEASES-MINNEAPOLIS-LTD

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	207RI0200X	Infectious Disease Physician	834	MN

General Provider Information

NPI Number	:	1184722464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFECTIOUS DISEASES-MINNEAPOLIS-LTD

Provider Business Mailing Address
First Line	:	5700 BOTTINEAU BLVD
Second Line	:	SUITE 270
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55429-3183
Country	:	US
Telephone Number	:	763-520-4320
Fax Number	:	763-520-7055

Provider Business Practice Location Address
First Line	:	5700 BOTTINEAU BOULEVARD
Second Line	:	SUITE 270
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55429-3183
Country	:	US
Telephone Number	:	763-520-4320
Fax Number	:	763-520-7055

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTIAN GERALD SCHROCK
Credential	:	M.D.
Telephone Number	:	763-520-4320

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/20/2016

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