Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Olaf Jonathan Rustad, MD

Individual provider Dermatology Physician · NPI 1174586440

Olaf Jonathan Rustad, MD is a Dermatology in White Bear Lake, Minnesota. Qualified in 1989, 37 years ago. Practices with Advanced Dermatology Care Medical Cosmetic and Surgery PA, a 7-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
37
Licensed in
MN
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

4480 Centerville Rd
White Bear Lake, MN 55127-3674
Phone: (651) 484-2724
Fax: (651) 484-2723
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 1938363 (MN)

Record details

NPI number1174586440
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 8, 2006
Last updated in NPPESSeptember 29, 2010
Mailing address4480 Centerville Road, White Bear Lake, MN 55127-3674

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDERMATOLOGY
Medical schoolOTHER
Graduated 1989 (37 years in practice)
Group practice Advanced Dermatology Care Medical Cosmetic And Surgery Pa — 7 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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