Provider Demographics
NPI:1235134354
Name:ROCK, PATRICK MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:ROCK
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 1:8996 TEWSBURY GATE
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-1126
Mailing Address - Country:US
Mailing Address - Phone:612-721-9856
Mailing Address - Fax:612-721-2904
Practice Address - Street 1:1315 E 24TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3975
Practice Address - Country:US
Practice Address - Phone:612-721-9856
Practice Address - Fax:612-721-2904
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG30271Medicare UPIN