Individual
RONDA FARAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
14500 99TH AVE N, MAPLE GROVE, MN 55369-4730
(763) 898-1570
(763) 898-1576
Mailing address
14500 99TH AVE N, MAPLE GROVE, MN 55369-4730
(763) 898-1570
(763) 898-1576
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
40182
IA
207N00000X
Dermatology Physician
Primary
58018
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386963536
—
MN
01
—
H400141467
MEDICARE PTAN
MN
Enumeration date
05/27/2010
Last updated
07/30/2014
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