Individual
RANDALL J ROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 DELLWOOD ST S, CAMBRIDGE, MN 55008-1920
(763) 689-8700
(763) 689-7941
Mailing address
2925 CHICAGO AVENUE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35813
MN
207Q00000X
Family Medicine Physician
Primary
35813
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
716870500
—
MN
Enumeration date
08/03/2006
Last updated
05/31/2023
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