Basic Information
| Provider Information | |||||||||
| NPI: | 1013053982 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RHEAULT | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 WASHINGTON AVE SE | ||||||||
| Address2: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128840649 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2512 S 7TH ST | ||||||||
| Address2: | PEDIATRIC SPECIALTY CARE | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123656777 | ||||||||
| FaxNumber: | 6126241446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 02/20/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0210X | 242353 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology | 2080P0210X | 44250 | MN | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology |
No ID Information.