Organization
SOUTHDALE OTOLARYNGOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT H ROSENBERG MD (PRESIDENT)
(952) 896-3166
Entity
Organization
Contact information
Practice address
7373 FRANCE AVENUE S, STE 302, EDINA, MN 55435-4538
(952) 896-3166
(952) 896-9853
Mailing address
7373 FRANCE AVENUE S, STE 302, EDINA, MN 55435-4538
(952) 896-3166
(952) 896-9853
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
PF128
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120554
UCARE
—
01
—
16625SO
BCBS
—
01
—
179
HEALTH PARTNERS
—
01
—
20401006
METROPOLITAN HEALTH PLAN
—
05
—
465510900
—
MN
01
—
CT0375
RR MEDICARE
—
01
—
D669
UCARE
—
Enumeration date
11/17/2006
Last updated
06/06/2011
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