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NPI Code Detail

MEDICARE: ROBERT A MITTRA MD

MEDICARE: ROBERT A MITTRA 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
1207W00000XOphthalmology Physician42976MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699764456
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT A MITTRA MD
Provider Business Mailing Address
First Line : 7760 FRANCE AVE S
Second Line : SUITE 310
City : MINNEAPOLIS
State : MN
Zip : 55435-5800
Country : US
Telephone Number : 952-929-1131
Fax Number : 952-897-1178
Provider Business Practice Location Address
First Line : 7760 FRANCE AVE S
Second Line : SUITE 310
City : MINNEAPOLIS
State : MN
Zip : 55435-5800
Country : US
Telephone Number : 952-929-1131
Fax Number : 952-897-1178
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2005
Last Update Date : 11/03/2010

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