MEDICARE: RAHEL NARDOS M.D. MCR

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	207VG0400X	Gynecology Physician	2007015345	MO
2	207VH0002X	Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician	2003016145	MO
3	207V00000X	Obstetrics & Gynecology Physician	67298	MN
4	2088F0040X	Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician	67298	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	67298	OTHER	MN	MEDICAL LICENCE

General Provider Information

NPI Number	:	1912111592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAHEL NARDOS M.D. MCR

Provider Business Mailing Address
First Line	:	720 WASHINGTON AVE SE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-2924
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 24TH AVE S STE 300
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-1437
Country	:	US
Telephone Number	:	612-273-7111
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	10/13/2022

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Directions to “ RAHEL NARDOS M.D. MCR” Practice Location

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