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NPI Code Detail

MEDICARE: ROLF F. ULVESTAD M.D.

MEDICARE: ROLF F. ULVESTAD M.D.
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
1207Y00000XOtolaryngology Physician21818MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10218007OTHERMNPREFERREDONE
221000OTHERMNAMERICA'S PPO
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
462D66ULOTHERMNBLUE SHIELD
51000010OTHERMNMEDICA PRIMARY
61005553OTHERMNMEDICA CHOICE
7102264OTHERMNUCARE
8MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265434195
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROLF F. ULVESTAD M.D.
Provider Business Mailing Address
First Line : 2211 PARK AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-3711
Country : US
Telephone Number : 612-871-1144
Fax Number : 612-871-2012
Provider Business Practice Location Address
First Line : 2211 PARK AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-3711
Country : US
Telephone Number : 612-871-1144
Fax Number : 612-871-2012
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 07/17/2013

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