Healthcare Provider Details

I. General information

NPI: 1043623879
Provider Name (Legal Business Name): SADHANA VANKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 NICOLLET AVE
MINNEAPOLIS MN
55408
US

IV. Provider business mailing address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-6963
  • Fax: 612-545-9049
Mailing address:
  • Phone: 763-873-3000
  • Fax: 612-873-1928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61493
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number61493
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: