Provider Demographics
NPI:1558688366
Name:ROLFES, BRYAN NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:NICHOLAS
Last Name:ROLFES
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 1:935 WAYZATA BLVD E STE 200
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-2513
Mailing Address - Country:US
Mailing Address - Phone:763-559-4500
Mailing Address - Fax:
Practice Address - Street 1:935 WAYZATA BLVD E STE 200
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-2513
Practice Address - Country:US
Practice Address - Phone:763-559-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60565207YX0905X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program