Provider Demographics
NPI:1356361489
Name:ROSENBAUM, SETH (MD)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:ROSENBAUM
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 1:10800 LYNDALE AVE S
Mailing Address - Street 2:SUITE 232
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-5614
Mailing Address - Country:US
Mailing Address - Phone:952-346-9523
Mailing Address - Fax:952-346-9531
Practice Address - Street 1:10800 LYNDALE AVE S
Practice Address - Street 2:SUITE 232
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-5614
Practice Address - Country:US
Practice Address - Phone:952-346-9523
Practice Address - Fax:952-346-9531
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23776208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
B97978Medicare UPIN
MN25000294Medicare ID - Type Unspecified