Provider Demographics
NPI:1114926219
Name:NESHEIM, ROBERT SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:NESHEIM
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 1:408 SAINT PETER ST
Mailing Address - Street 2:STE 429
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1130
Mailing Address - Country:US
Mailing Address - Phone:651-224-0614
Mailing Address - Fax:651-224-5754
Practice Address - Street 1:408 SAINT PETER ST
Practice Address - Street 2:STE 429
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1130
Practice Address - Country:US
Practice Address - Phone:651-224-0614
Practice Address - Fax:651-224-5754
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN229202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
15-79433OtherUBH
WI31464400Medicaid
MN77D45NEOtherBCBSMN DFPC
HP25137OtherHEALTHPARTNERS
112721OtherUCARE
15-39434OtherMEDICA
MN183380400Medicaid
089R2NEOtherBC/BS
1010589OtherPREFERRED ONE
260042215Medicare ID - Type UnspecifiedRAILROAD
15-79433OtherUBH
HP25137OtherHEALTHPARTNERS
260001922Medicare ID - Type Unspecified