Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MT187664 | PA |
N | 111NI0900X | Internist | MT187664 | PA |
N | 207RR0500X | Rheumatology | 104288 | MN |
Y | 207RR0500X | Rheumatology | 52139 | MN |
NPI | 1023174323 |
---|---|
Provider Name | Bharath Manu Akkara Veetil |
First Address | Saint Cloud, MN 56303-2735 |
Second Address | Saint Cloud, MN 56303-2735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 03/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | MN |
P00787815 | RAILROAD MEDICARE (01) | MN |