Provider Demographics
NPI:1043879901
Name:ROCKET SURGERY, LLC
Entity Type:Organization
Organization Name:ROCKET SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-389-1093
Mailing Address - Street 1:11407 CREEKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-4311
Mailing Address - Country:US
Mailing Address - Phone:612-389-1093
Mailing Address - Fax:
Practice Address - Street 1:6565 FRANCE AVE S STE 350
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2159
Practice Address - Country:US
Practice Address - Phone:952-999-9049
Practice Address - Fax:952-999-4081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center