Provider Demographics
NPI:1891990404
Name:RATHMANN, GREGORY ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALLAN
Last Name:RATHMANN
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 1:2355 HIGHWAY 36 W STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3905
Mailing Address - Country:US
Mailing Address - Phone:651-292-2000
Mailing Address - Fax:
Practice Address - Street 1:2355 HIGHWAY 36 W STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3905
Practice Address - Country:US
Practice Address - Phone:651-292-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN501122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP78435OtherHEALTH PARTNERS
MNP00406914OtherRAILROAD MEDICARE
MN134436OtherUCARE
WI34911200Medicaid
MN1891990404OtherAMERICA'S PPO
MN300004211OtherMEDICARE
MN960371004676OtherPREFERRED ONE
MN16-04895OtherMEDICA
MN170453000Medicaid
MN1891990404Medicaid
MN6G394RAOtherBLUE CROSS BLUE SHIELD
MN300004210OtherMEDICARE
MN300004210OtherMEDICARE