Provider Demographics
NPI:1578530390
Name:ROLFE, PHILLIP BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:BENJAMIN
Last Name:ROLFE
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 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5790
Mailing Address - Fax:952-883-5396
Practice Address - Street 1:1833 2ND AVE S
Practice Address - Street 2:MAIL STOP 39300A
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2432
Practice Address - Country:US
Practice Address - Phone:763-712-6000
Practice Address - Fax:763-712-6475
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN35307208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
C39310Medicare UPIN