Active NPI
Thomas F Rolewicz, M.D.
- Pediatrics Physician
- Fridley, MN
National Provider Identifier
1194833210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 17774
- Practice address
- 6341 University Ave NE
Fridley, MN 55432-4946 - Phone
- (763) 572-5710
- Fax
- (763) 586-5888
- NPI assigned
- Aug 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 17774 | MN | Primary |
Addresses
Primary practice location
6341 University Ave NE
Fridley, MN 55432-4946
Mailing address
6401 University Ave NE
Fridley, MN 55432-4341
Phone (763) 572-5710
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 105931 | Other | MN | UCARE MN |
| HP17050 | Other | MN | HEALTHPARTNERS |
| 016K7RO | Other | MN | BCBS OF MN |
| 4415076 | Other | MN | AETNA INS |
| 1018891 | Other | MN | PREFERRED ONE |
| 1778438 | Other | MN | AMERICA'S PPO |
| 1202445 | Other | MN | MEDICA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17774 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1194833210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6401 UNIVERSITY AVE NE",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "554324341",
"telephone_number": "763-572-5710",
"fax_number": "763-571-3008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6341 UNIVERSITY AVE NE",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "554324946",
"telephone_number": "763-572-5710",
"fax_number": "763-586-5888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROLEWICZ",
"first_name": "THOMAS",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-28",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "17774",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE MN",
"identifier": "105931",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP17050",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MN",
"identifier": "016K7RO",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA INS",
"identifier": "4415076",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1018891",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICA'S PPO",
"identifier": "1778438",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "1202445",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fridley, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.