Healthcare Provider Details

I. General information

NPI: 1053378422
Provider Name (Legal Business Name): RAHUL KORANNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 BEAM AVE
MAPLEWOOD MN
55109-1126
US

IV. Provider business mailing address

1690 UNIVERSITY AVE W STE 370
SAINT PAUL MN
55104-3723
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-7800
  • Fax:
Mailing address:
  • Phone: 651-232-5321
  • Fax: 651-326-8170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number41656
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number41656
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: