Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 50493 | MN |
NPI | 1033301858 |
---|---|
Provider Name | Suresh Devineni |
First Address | Mankato, MN 56001-5066 |
Second Address | Mankato, MN 56001-5066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2007 |
Last Update Date | 10/07/2020 |