Provider Demographics
NPI:1528011269
Name:ROSIELLE, DREW A (MD)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:A
Last Name:ROSIELLE
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 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-672-6362
Mailing Address - Fax:612-273-3891
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:MAYO BUILDING B344 MMC 603
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-273-3671
Practice Address - Fax:612-273-4891
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI477332080P0207X
MN52873207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34641600Medicaid
007806261VOtherHUMANA
WI34641600Medicaid
0083S73601Medicare ID - Type Unspecified