Healthcare Provider Details

I. General information

NPI: 1437679024
Provider Name (Legal Business Name): NAVYATHA MOHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 FULTON ST SE STE 318
MINNEAPOLIS MN
55455-4800
US

IV. Provider business mailing address

1700 UNIVERSITY AVE W FL 6
SAINT PAUL MN
55104-3727
US

V. Phone/Fax

Practice location:
  • Phone: 612-626-6688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberBP10060958
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number83188
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: