MEDICARE: MR. RODNEY S MARTEL L.P.

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	103T00000X	Psychologist	LP2137	MN

General Provider Information

NPI Number	:	1720370042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RODNEY S MARTEL L.P.

Provider Business Mailing Address
First Line	:	4012 LINDEN HILLS BLVD.
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-1246
Country	:	US
Telephone Number	:	612-928-0896
Fax Number	:

Provider Business Practice Location Address
First Line	:	4012 LINDEN HILLS BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-1246
Country	:	US
Telephone Number	:	612-928-0896
Fax Number	:

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

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	05/04/2011

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