Provider Demographics
NPI:1518933985
Name:RONDESTVEDT, PAUL CHRISTIAN (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:CHRISTIAN
Last Name:RONDESTVEDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UNITY HOSPICE AND PALLIATIVE CARE OF SOUTHERN WISCONSIN
Mailing Address - Street 2:7633 GRANSER WAY, SUITE 102
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719
Mailing Address - Country:US
Mailing Address - Phone:608-515-5300
Mailing Address - Fax:
Practice Address - Street 1:5200 FAIRVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-8013
Practice Address - Country:US
Practice Address - Phone:651-982-7300
Practice Address - Fax:651-982-7301
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN37224207Q00000X, 207QH0002X
WI74526-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG30132Medicare UPIN