Basic Information
| Provider Information | |||||||||
| NPI: | 1578530390 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROLFE | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | BENJAMIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8100 34TH AVE S | ||||||||
| Address2: | 21110Q | ||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554251672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528835790 | ||||||||
| FaxNumber: | 9528835396 | ||||||||
| Practice Location | |||||||||
| Address1: | 1833 2ND AVE S | ||||||||
| Address2: | MAIL STOP 39300A | ||||||||
| City: | ANOKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553032432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637126000 | ||||||||
| FaxNumber: | 7637126475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35307 | MN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.