Provider Demographics
NPI:1013053339
Name:ROTILIE, TOMAN, MCRAITH, LLC
Entity Type:Organization
Organization Name:ROTILIE, TOMAN, MCRAITH, LLC
Other - Org Name:SAINT PAUL PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:ROTILIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-219-1269
Mailing Address - Street 1:2300 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1137
Mailing Address - Country:US
Mailing Address - Phone:651-291-1269
Mailing Address - Fax:651-291-0957
Practice Address - Street 1:2300 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1137
Practice Address - Country:US
Practice Address - Phone:651-291-1269
Practice Address - Fax:651-291-0957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1584207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty