Provider Demographics
NPI:1295711265
Name:ULLAND, ROLF PETER (MD)
Entity type:Individual
Prefix:DR
First Name:ROLF
Middle Name:PETER
Last Name:ULLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:PETER
Other - Last Name:ULLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:870 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3291
Mailing Address - Country:US
Mailing Address - Phone:651-326-5650
Mailing Address - Fax:651-326-5671
Practice Address - Street 1:870 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3291
Practice Address - Country:US
Practice Address - Phone:651-326-5650
Practice Address - Fax:651-326-5671
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25116207V00000X
WI23596207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30289400Medicaid
MNA95643Medicare UPIN
WI001456150Medicare PIN