Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125060753 | IL |
N | 111NI0900X | Internist | 125060753 | IL |
Y | 207RC0200X | Critical Care Medicine | 66624 | MN |
N | 207RN0300X | Nephrologist | 55575 | AZ |
NPI | 1063776417 |
---|---|
Provider Name | Dr. Jacob Ninan |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2012 |
Last Update Date | 03/09/2020 |