Provider Demographics
NPI:1639604606
Name:ROSARIO GRAU MD PA
Entity Type:Organization
Organization Name:ROSARIO GRAU MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA DEL ROSARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-225-0176
Mailing Address - Street 1:6542 REGENCY LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7847
Mailing Address - Country:US
Mailing Address - Phone:612-225-0176
Mailing Address - Fax:612-808-6738
Practice Address - Street 1:6542 REGENCY LN
Practice Address - Street 2:SUITE 205
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7847
Practice Address - Country:US
Practice Address - Phone:612-225-0176
Practice Address - Fax:612-808-6738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN345972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH300279329OtherMEDICARE PTAN
MN946883800Medicaid
MN946883800Medicaid
MN1512897OtherMEDICA
MN946883800Medicaid