Provider Demographics
NPI:1770504995
Name:RIOS, RODRIGO (MD)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:RIOS
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 1:2530 CHICAGO AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4291
Mailing Address - Country:US
Mailing Address - Phone:612-813-8800
Mailing Address - Fax:612-813-8825
Practice Address - Street 1:2530 CHICAGO AVE
Practice Address - Street 2:STE 500
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4291
Practice Address - Country:US
Practice Address - Phone:612-813-8800
Practice Address - Fax:612-813-8825
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN377662080P0202X
ND69522080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F31180Medicare UPIN