Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 69257 | MN |
NPI | 1063874881 |
---|---|
Provider Name | Dr. Vishnuteja V Devalla |
First Address | Fargo, ND 58103-4940 |
Second Address | Brainerd, MN 56401-4529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 03/08/2021 |