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NPI Code Detail

MEDICARE: TEIJA MADHUSOODANAN

MEDICARE: TEIJA MADHUSOODANAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RN0300XNephrology Physician72189MN

General Provider Information

NPI Number : 1902338791
Entity Type Code : Individual
Provider Name (Legal Business Name) : TEIJA MADHUSOODANAN
Provider Business Mailing Address
First Line : 6600 FRANCE AVE S STE 162
Second Line :
City : EDINA
State : MN
Zip : 55435-1802
Country : US
Telephone Number : 612-730-8674
Fax Number :
Provider Business Practice Location Address
First Line : 6600 FRANCE AVE S STE 162
Second Line :
City : EDINA
State : MN
Zip : 55435-1802
Country : US
Telephone Number : 952-920-2070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2017
Last Update Date : 10/04/2022

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Directions to “ TEIJA MADHUSOODANAN ” Practice Location

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