Rustad, Olaf Jonathan

Rustad, Olaf Jonathan is an individual health care provider with primary practice located at 4480 Centerville Road , White Bear Lake MN 55127-3674. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Rustad, Olaf Jonathan can be contacted via phone (651) 484-2724.

Contact Information

Primary practice address
4480 Centerville Road White Bear Lake MN 55127-3674
Fax: (651) 484-2723
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 1938363 Minnesota

Profile Details

NPI number 1174586440
LBN Legal business name Rustad, Olaf Jonathan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 8th, 2006
Last updated Sep 29th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174586440 NPPES
Other 070003227 RR MEDICARE PIN

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