Provider Demographics
NPI:1518004803
Name:ROOS, KARL PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:PHILIP
Last Name:ROOS
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 1:1230 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:507-385-4008
Practice Address - Street 1:1230 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56002
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:507-385-4008
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL-1590390200000X
MN54890207RN0300X
CO46174207R00000X
UT7299347-1205207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine