Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 9837 | ND |
NPI | 1003843574 |
---|---|
Provider Name | Bangalore S Vijayalakshmi |
First Address | Fargo, ND 58108-6001 |
Second Address | Fargo, ND 58103-4940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 22/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13283 | (05) | ND |
137123 | UCARE # (01) | ND |
2265220 | AMERICA'S PPO/ARAZ # (01) | ND |
2300320 | MEDICA # (01) | ND |
2300322 | MEDICA # (01) | ND |
25030 | NDBS # (01) | ND |
363627500 | (05) | ND |
38107 | LHS # (01) | ND |
927S3VI | MNBS # (01) | ND |
DA9011042827 | PREFERRED ONE # (01) | ND |
HP48628 | HEALTHPARTNERS # (01) | ND |
I22403 | (02) | ND |