Provider Demographics
NPI:1982653978
Name:UGARTE, ROLAND RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:RENE
Last Name:UGARTE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6525 FRANCE AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2148
Mailing Address - Country:US
Mailing Address - Phone:952-927-6501
Mailing Address - Fax:952-653-1435
Practice Address - Street 1:6525 FRANCE AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2148
Practice Address - Country:US
Practice Address - Phone:952-927-6501
Practice Address - Fax:952-653-1435
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2012-01-26
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Provider Licenses
StateLicense IDTaxonomies
MN31218208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN674888100Medicaid
MN674888100Medicaid
MNB58419Medicare UPIN