Organization
OMNI MEDICAL CENTER PLLC
Active
Other names
Omni Cosmetic
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN NICHOLAS ROLFES MD (PHYSICIAN)
(763) 559-4500
Entity
Organization
Contact information
Practice address
935 WAYZATA BLVD E STE 200, WAYZATA, MN 55391-2513
(763) 559-4500
(763) 559-1733
Mailing address
935 WAYZATA BLVD E STE 200, WAYZATA, MN 55391-2513
(763) 559-4500
(763) 559-1733
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659845659
OTHER INS
—
Enumeration date
01/14/2019
Last updated
05/15/2019
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