Healthcare Provider Details

I. General information

NPI: 1669662524
Provider Name (Legal Business Name): ASHOK SESHADRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 1ST DR NW
AUSTIN MN
55912-2941
US

IV. Provider business mailing address

1000 1ST DR NW
AUSTIN MN
55912-2941
US

V. Phone/Fax

Practice location:
  • Phone: 507-433-8758
  • Fax:
Mailing address:
  • Phone: 507-433-8758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number57084
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number57084
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: