Provider Demographics
NPI:1164490793
Name:ROCK, ANN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:ROCK
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 1:1000 E 1ST ST
Mailing Address - Street 2:SUITE LL
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:218-722-5629
Mailing Address - Fax:218-722-5148
Practice Address - Street 1:1000 E 1ST ST
Practice Address - Street 2:SUITE LL
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2297
Practice Address - Country:US
Practice Address - Phone:218-722-5629
Practice Address - Fax:218-722-5148
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28801174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0719246OtherMEDICA
HP22610OtherHEALTH PARTNERS
50204ROOtherBLUE CROSS OF MN
111078OtherUCARE
A007OtherTRICARE
346004OtherPREFERRED ONE
WI3097150Medicaid
346004OtherPREFERRED ONE