Provider Demographics
NPI:1881673879
Name:STORVICK, ROLF E (MD)
Entity Type:Individual
Prefix:
First Name:ROLF
Middle Name:E
Last Name:STORVICK
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:PO BOX 8674
Mailing Address - Street 2:1230 E MAIN ST
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1230 E MAIN STREET
Practice Address - Street 2:MANKATO CLINIC
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56002-8674
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27381207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110103564OtherRR MEDICARE
115515OtherUCARE MN
MN543272400Medicaid
HP25869OtherHEALTH PARTNERS MN
41631STOtherBCBS MN
IA938480Medicaid
NA2951014383OtherPREFERRED ONE MN
41084933956001C068OtherCHAMPUS
1657921OtherAMERICAS PPO MN
3100933OtherMEDICA MN
MN399000005Medicare ID - Type Unspecified
41084933956001C068OtherCHAMPUS