MEDICARE: ROBERT CHRISTOPHER ROTHAAR MD

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	42056	MN

General Provider Information

NPI Number	:	1568442853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT CHRISTOPHER ROTHAAR MD

Provider Business Mailing Address
First Line	:	6550 FOUNTAIN LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-3764
Country	:	US
Telephone Number	:	617-699-2594
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 FOUNTAIN LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-3764
Country	:	US
Telephone Number	:	617-983-9064
Fax Number	:

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	08/25/2025

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