Provider Demographics
NPI:1467546549
Name:SCHROCK, CHRISTIAN GERALD (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:GERALD
Last Name:SCHROCK
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 1:5700 BOTTINEAU BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3183
Mailing Address - Country:US
Mailing Address - Phone:763-520-4320
Mailing Address - Fax:763-520-7055
Practice Address - Street 1:5700 BOTTINEAU BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55429-3183
Practice Address - Country:US
Practice Address - Phone:763-520-4320
Practice Address - Fax:763-520-7055
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21961207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN866283500Medicaid
MNA96006Medicare UPIN
MN440000007Medicare PIN