Provider Demographics
NPI:1083686281
Name:RETHWILL, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:RETHWILL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:MAIL STOP 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5463
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:2165 WHITE BEAR AVENUE
Practice Address - Street 2:MAIL STOP 31600A
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2798
Practice Address - Country:US
Practice Address - Phone:651-779-1500
Practice Address - Fax:651-770-3371
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN25731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B56007Medicare UPIN