Provider Demographics
NPI:1578598553
Name:ROHLA, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:ROHLA
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:701-364-8906
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11792Medicaid
ND22892OtherNDBS #
NDHP21534OtherHEALTHPARTNERS #
ND0112096OtherMEDICA #
ND20107OtherAMERICA/S PPO/ARAZ #
ND363H6ROOtherMNBS #
ND0112093OtherMEDICA #
ND37910OtherLHS #
ND0114513OtherMEDICA #
ND348J8ROOtherMNBS #
ND726005900Medicaid
ND116736OtherUCARE #
NDDA9011008294OtherPREFERRED ONE #
NDDA9011008294OtherPREFERRED ONE #
ND22892OtherNDBS #
ND080012790Medicare ID - Type UnspecifiedMN MEDICARE #
ND11792Medicaid
ND22892Medicare ID - Type UnspecifiedND MEDICARE #