Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 52651 | MN |
N | 204F00000X | Transplant Surgeon | L2843 | TX |
NPI | 1376579698 |
---|---|
Provider Name | Dr. Srinath Chinnakotla |
First Address | Minneapolis, MN 55455-0341 |
Second Address | Minneapolis, MN 55455-0356 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 13/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1487852-03 | (05) | TX |
1487852-04 | (05) | TX |
8H3714 | BCBS (01) | TX |
H53679 | (02) | TX |