Provider Demographics
NPI:1811420466
Name:ROKOSZ, MICHAELA (MD)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:ROKOSZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 PARKLAWN AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5660
Mailing Address - Country:US
Mailing Address - Phone:952-278-7000
Mailing Address - Fax:952-898-5914
Practice Address - Street 1:3955 PARKLAWN AVE STE 120
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5660
Practice Address - Country:US
Practice Address - Phone:952-278-7000
Practice Address - Fax:952-898-5914
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN67013261QM1300X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program