Provider Demographics
NPI:1912101114
Name:FRATTALONE, ANTHONY ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ROBERT
Last Name:FRATTALONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55485-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:651-254-7904
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101
Practice Address - Country:US
Practice Address - Phone:651-254-7900
Practice Address - Fax:651-254-7904
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD105192084A2900X
MN635442084N0400X
FLME1635342084N0400X
NE392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care