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Organization

OMNI FACIAL PLASTIC SURGERY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BRYAN NICHOLAS ROLFES MD (PHYSICIAN)
(320) 774-2411
Entity
Organization

Contact information

Practice address
935 WAYZATA BLVD E STE 200, WAYZATA, MN 55391-2513
(320) 559-4500
Mailing address
935 WAYZATA BLVD E STE 200, WAYZATA, MN 55391-2513
(320) 559-4500

Taxonomy

Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2018
CLA
MN
Enumeration date
12/03/2019
Last updated
12/03/2019
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