Basic Information
| Provider Information | |||||||||
| NPI: | 1881673879 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STORVICK | ||||||||
| FirstName: | ROLF | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8674 | ||||||||
| Address2: | 1230 E MAIN ST | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560028674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1230 E MAIN STREET | ||||||||
| Address2: | MANKATO CLINIC | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560028674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 08/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 27381 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 27381 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 110103564 | 01 | RR MEDICARE | OTHER | 115515 | 01 | UCARE MN | OTHER | 543272400 | 05 | MN | MEDICAID | HP25869 | 01 | HEALTH PARTNERS MN | OTHER | 41631ST | 01 | BCBS MN | OTHER | 938480 | 05 | IA | MEDICAID | NA2951014383 | 01 | PREFERRED ONE MN | OTHER | 41084933956001C068 | 01 | CHAMPUS | OTHER | 1657921 | 01 | AMERICAS PPO MN | OTHER | 3100933 | 01 | MEDICA MN | OTHER |