Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 01085758A | IN |
NPI | 1114314374 |
---|---|
Provider Name | Vedant Borad |
First Address | Minneapolis, MN 55455-0341 |
Second Address | Minneapolis, MN 55455-0341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2015 |
Last Update Date | 28/07/2021 |