Provider Demographics
NPI:1144222548
Name:WALKOWSKI, ROBERT J (PAC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:WALKOWSKI
Suffix:
Gender:M
Credentials:PAC
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Mailing Address - Street 1:7801 E BUSH LAKE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3120
Mailing Address - Country:US
Mailing Address - Phone:952-985-8911
Mailing Address - Fax:952-985-8999
Practice Address - Street 1:7373 FRANCE AVE S
Practice Address - Street 2:202 CENTENNIAL LAKES MEDICAL CENTER
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4534
Practice Address - Country:US
Practice Address - Phone:952-985-8100
Practice Address - Fax:952-985-8199
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-03-11
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Provider Licenses
StateLicense IDTaxonomies
MN9156363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN069319700Medicaid