Provider Demographics
NPI:1518949239
Name:GRAU, MARIA DEL ROSARIO (MD)
Entity Type:Individual
Prefix:
First Name:MARIA DEL ROSARIO
Middle Name:
Last Name:GRAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 HENNEPIN AVE S
Mailing Address - Street 2:PO BOX 577
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2751 HENNEPIN AVE STE 577
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1002
Practice Address - Country:US
Practice Address - Phone:612-225-0176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN345972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH300279329OtherMEDICARE PTAN
MN946883800Medicaid
MN1512897OtherMEDICA
MN946883800Medicaid
MN946883800Medicaid