Basic Information
| Provider Information | |||||||||
| NPI: | 1518004803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROOS | ||||||||
| FirstName: | KARL | ||||||||
| MiddleName: | PHILIP | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1230 EAST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
| FaxNumber: | 5073854008 | ||||||||
| Practice Location | |||||||||
| Address1: | 1230 EAST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
| FaxNumber: | 5073854008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 07/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | TL-1590 | CO | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RN0300X | 54890 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | 46174 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 7299347-1205 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 7299347-1205 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.