MEDICARE: JANE E VANROEKEL

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	208000000X	Pediatrics Physician	21669	MN

General Provider Information

NPI Number	:	1700948536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANE E VANROEKEL

Provider Business Mailing Address
First Line	:	1399 FELIX ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55118-3207
Country	:	US
Telephone Number	:	651-457-0987
Fax Number	:

Provider Business Practice Location Address
First Line	:	5975 CARMEN AVE
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-4416
Country	:	US
Telephone Number	:	651-455-9697
Fax Number	:

Authorized Official
Title or Position	:	OWNER-MEDICAL DIRECTOR
Name	:	JANE E VANROEKEL
Credential	:	MD
Telephone Number	:	651-455-9697

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	08/22/2020

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