OLAF JONATHAN RUSTAD (NPI# 1174586440) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174586440 |
| Entity Type | Individual |
| Full Name | OLAF JONATHAN RUSTAD |
| Other Name | OLAF JONATHAN RUSTAD |
| Credential | MD |
| Practice Address |
4480 Centerville Road White Bear Lake MN 55127-3674 |
| Practice Telephone | 6514842724 |
| Practice Fax Number | 6514842723 |
| Mailing Telephone | 6514842724 |
| Mailing Fax Number | 6514842723 |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2010-09-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 1938363 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RR MEDICARE PIN | 070003227 | 01 |
| Street Address |
4480 CENTERVILLE ROAD |
| City | WHITE BEAR LAKE |
| State | MN |
| Zip Code | 55127-3674 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013514058 | Taylor Nessa Draves | Behavior Technician | 1011 Meadowlamds Dr, White Bear Lake, MN 55127 | 2020-10-02 |
| 1578104196 | Patricia Lynn Bina | Technician | 3677 Centerville Rd, Vadnais Heights, MN 55127 | 2019-10-04 |
| 1023538469 | Dignicare Senior Management of Vadnais | Assisted Living Facility | 580 Liberty Way, Vadnais Heights, MN 55127 | 2017-06-27 |
| 1548610207 | Golden Elderly Care Suites LLC | Assisted Living Facility | 4624 Stoddart Circle, White Bear Lake, MN 55127 | 2016-06-14 |
| 1811018203 | Adam F Curtis | Dentist | 925 East County Road E, Suite 185, Vadnais Heights, MN 55127 | 2007-04-03 |
| 1134215700 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 785 E County Road E, Vadnais Heights, NE 55127 | 2006-10-04 |
| 1861404790 | Gerald James Pease | Optometrist | 850 East Co Rd E, Walmart Vision Center, Vadnais Heights, MN 55127 | 2006-08-12 |
| 1235629395 | Suite Living Senior Management | Assisted Living Facility | 197 County Road B2 W, Roseville, MN 55127 | 2018-05-15 |
| 1760986624 | Diandra Shakira Williams | Physician Assistant | 3580 Arcade St, Vadnais Heights, MN 55127 | 2018-03-23 |
| 1811370729 | Sonya L Knudson | Psychologist | 4444 Centerville Rd Ste 235, White Bear Lake, MN 55127 | 2015-07-09 |
| Find all providers in zip 55127 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073614558 | Advanced Dermatology Care Medical Cosmetic and Surgery Pa | Dermatology | 4480 Centerville Rd, White Bear Lake, MN 55127-3674 | 2006-09-26 |
| 1689631038 | Ruth A Rustad | Dermatology | 4480 Centerville Rd, White Bear Lake, MN 55127-3674 | 2006-04-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962871608 | Lakes Dermatology, Pa | Dermatology | 14305 Southcross Dr W, Suite 110, Burnsville, MN 55306-7009 | 2015-09-23 |
| 1194133157 | Adam Schmitt | Dermatology | 2 Carlson Pkwy N Ste 240, Plymouth, MN 55447 | 2014-07-22 |
| 1578982773 | Lori Ann Fiessinger | Dermatology | 420 Delaware Street Se, Mmc 98, Minneapolis, MN 55455 | 2014-04-15 |
| 1942629795 | Shane O'neil | Dermatology | 500 Osborne Rd Ne Ste 330, Fridley, MN 55432 | 2014-04-09 |
| 1033537782 | Erin Sellinger | Dermatology | 2 Carlson Pkwy N, Ste 240, Plymouth, MN 55447-4485 | 2014-03-31 |
| 1033555230 | Samuel Blake Ecker | Dermatology | 3655 Plymouth Blvd Ste 110, Minneapolis, MN 55446-3665 | 2013-05-14 |
| 1295078913 | Jessica Jane Newman | Dermatology | 4-240, Phillips-wangensteen Bldg., 516 Delaware Street S.e., Mail Code 98, Minneapolis, MN 55455 | 2013-04-01 |
| 1437416088 | Tiffany Lynn Shih | Dermatology | 401 Phalen Blvd # Ms 41102b, Saint Paul, MN 55130-5302 | 2012-04-20 |
| 1124317383 | Sara Anne Hylwa | Dermatology | 730 South 8th Street, Department of Dermatology, Minneapolis, MN 55415 | 2011-03-28 |
| 1770885360 | Thomas Joseph Kalb | Dermatology | 13420 106th St., Young America, MN 55397-5401 | 2010-12-02 |
| Find all providers with the same taxonomy | ||||
| City | WHITE BEAR LAKE |
| Zip Code | 55127 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.