Provider Demographics
NPI:1790009595
Name:RODGERS, NATHAN JOSEPH (MD, MHA)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JOSEPH
Last Name:RODGERS
Suffix:
Gender:M
Credentials:MD, MHA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:EAST BUILDING, ROOM MB560, 8951H
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-626-2755
Mailing Address - Fax:612-626-2467
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:EAST BUILDING, ROOM MB560, 8951H
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-626-2755
Practice Address - Fax:612-626-2467
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2016-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ87842080P0202X
MN57063208000000X, 2080P0202X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program