Provider Demographics
NPI:1609007384
Name:SETH ROSENBAUM MD PA
Entity Type:Organization
Organization Name:SETH ROSENBAUM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-346-9523
Mailing Address - Street 1:10800 LYNDALE AVE S
Mailing Address - Street 2:SUITE 232
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-5614
Mailing Address - Country:US
Mailing Address - Phone:952-346-9523
Mailing Address - Fax:952-346-9531
Practice Address - Street 1:10800 LYNDALE AVE S
Practice Address - Street 2:SUITE 232
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-5614
Practice Address - Country:US
Practice Address - Phone:952-346-9523
Practice Address - Fax:952-346-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1519261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty