Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 31606 | MN |
NPI | 1093793739 |
---|---|
Provider Name | Sundeep Khosla |
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 | 04/01/2006 |
Last Update Date | 14/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110025680 | RAILROAD MEDICARE (01) | MN |
35176300 | (05) | WI |
495019400 | (05) | MN |
A57094 | (02) | |
ENROLLED | (05) | ID |
ENROLLED | (05) | MN |