Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 106863 | MN |
N | 111NI0900X | Internist | 106863 | MN |
N | 207R00000X | Internist | 200500494 | NC |
N | 111NI0900X | Internist | 200500494 | NC |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 57117 | MN |
N | 207RC0000X | Internist - Cardiovascular Disease | 57117 | MN |
NPI | 1508842048 |
---|---|
Provider Name | Dr. Thenappan Thenappan |
First Address | Greenville, NC 27834-5704 |
Second Address | Minneapolis, MN 55455-4800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 26/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
139T4 | BCBS NC (01) | NC |
5902350 | (05) | NC |
I32965 | (02) | NC |