Individual
ROSS GOLLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3850 PARK NICOLLET BLVD, ST LOUIS PARK, MN 55416-2527
(952) 883-1000
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9904
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
726130600
—
MN
Enumeration date
07/24/2006
Last updated
05/31/2023
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