Provider Demographics
NPI:1699764456
Name:MITTRA, ROBERT A (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:MITTRA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7760 FRANCE AVE S
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5800
Mailing Address - Country:US
Mailing Address - Phone:952-929-1131
Mailing Address - Fax:952-897-1178
Practice Address - Street 1:7760 FRANCE AVE S
Practice Address - Street 2:SUITE 310
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55435-5800
Practice Address - Country:US
Practice Address - Phone:952-929-1131
Practice Address - Fax:952-897-1178
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2010-11-03
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Provider Licenses
StateLicense IDTaxonomies
MN42976207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN717645700Medicaid
WI32448600Medicaid
WI32448600Medicaid
MN717645700Medicaid