Provider Demographics
NPI:1285704916
Name:ROTHENBERGER, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:ROTHENBERGER
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE STREET SE MMC 195
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-1999
Mailing Address - Fax:612-626-0654
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:PWB - FIRST FLOOR, CLINIC 1-E
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-626-1999
Practice Address - Fax:612-626-0654
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2015-06-08
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Provider Licenses
StateLicense IDTaxonomies
MN21999208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0010839OtherPREFERRED ONE
MN14-22591OtherMEDICA CHOICE
MN100428OtherUCARE
MN01T37ROOtherBLUE CROSS BLUE SHIELD
IA0973602Medicaid
MNHP14281OtherHEALTH PARTNERS
MN14-00032OtherMEDICA PRIMARY
MN683595300Medicaid
MN768328OtherARAZ
A94723Medicare UPIN
MN0010839OtherPREFERRED ONE
MN100428OtherUCARE