Provider Demographics
NPI:1033170584
Name:RICH, ROBERT HAMPTON (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HAMPTON
Last Name:RICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 CHICAGO AVE
Mailing Address - Street 2:#550
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4289
Mailing Address - Country:US
Mailing Address - Phone:612-813-8000
Mailing Address - Fax:612-813-8005
Practice Address - Street 1:2530 CHICAGO AVE
Practice Address - Street 2:#550
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4289
Practice Address - Country:US
Practice Address - Phone:612-813-8000
Practice Address - Fax:612-813-8005
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN214292086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN878362400Medicaid
MN878362400Medicaid
MNA96206Medicare UPIN