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Individual

DR. KEVIN R. ROACH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1285 NININGER RD, HASTINGS, MN 55033-1086
(651) 480-4200
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
40335
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
020037023
RAILROAD MEDICARE
MN
01
02F64RO
BLUE CROSS
MN
01
120840
UCARE MINNESOTA
MN
01
17-00169
MEDICA
MN
01
32371200
MEDICAID WI
MN
01
66-02258
MEDICA URGENT CARE
MN
01
764561
AMERICAS PPO
MN
01
942819400
GROUP HEALTH EAU CLAIRE
MN
05
942819400
MN
01
HP23558
HEALTH PARTNERS
MN
01
NA9141014588
PREFERRED ONE
MN
Enumeration date
03/15/2006
Last updated
10/27/2011
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