Healthcare Provider Details

I. General information

NPI: 1447254123
Provider Name (Legal Business Name): SHOBANA MURALI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 STINSON BLVD SUITE 100
MINNEAPOLIS MN
55421-3488
US

IV. Provider business mailing address

825 NICOLLET MALL STE 2000
MINNEAPOLIS MN
55402-2708
US

V. Phone/Fax

Practice location:
  • Phone: 612-788-1621
  • Fax: 612-788-8079
Mailing address:
  • Phone: 612-338-4861
  • Fax: 612-333-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number40582
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: