Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 11016272A | IN |
N | 208600000X | Surgeon | 11016272A | IN |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 69449 | MN |
NPI | 1124306824 |
---|---|
Provider Name | Amanda Rae Stram |
First Address | Indianapolis, IN 46201-3045 |
Second Address | Robbinsdale, MN 55422-2926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2011 |
Last Update Date | 18/06/2021 |