Provider Demographics
NPI:1861464398
Name:SCHURLE, DALE ROTH (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:ROTH
Last Name:SCHURLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DALE
Other - Middle Name:
Other - Last Name:SCHURLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8600 NICOLLET AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-2824
Mailing Address - Country:US
Mailing Address - Phone:952-541-2800
Mailing Address - Fax:952-886-7015
Practice Address - Street 1:8600 NICOLLET AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-2824
Practice Address - Country:US
Practice Address - Phone:952-541-2800
Practice Address - Fax:952-886-7015
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30518207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN440083600Medicaid
MN440083600Medicaid
D98181Medicare UPIN