Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 63284 | MN |
NPI | 1043574569 |
---|---|
Provider Name | Kannan Kasturi |
First Address | Fargo, ND 58103-4940 |
Second Address | Duluth, MN 55805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2012 |
Last Update Date | 13/06/2018 |