Individual
DR. KYLE MATTHEW ROCKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3165 DEMERS AVE - TRUYU AESTHETIC CENTER, GRAND FORKS, ND 58201-4049
(701) 780-6623
Mailing address
2401 DEMERS AVE, GRAND FORKS, ND 58201
(701) 780-1891
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
04-37503
KS
207N00000X
Dermatology Physician
Primary
15835
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003719342
MEDICARE
—
05
—
201101740A
—
KS
Enumeration date
10/26/2005
Last updated
10/28/2020
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