Healthcare Provider Details

I. General information

NPI: 1629206032
Provider Name (Legal Business Name): AJAY K DHADWAL MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 03/19/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE ST SE MMC 195
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

6451 N FEDERAL HWY STE 800
FORT LAUDERDALE FL
33308-1409
US

V. Phone/Fax

Practice location:
  • Phone: 612-365-5000
  • Fax:
Mailing address:
  • Phone: 548-372-5199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number88728
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA08690700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number71127
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number046756
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: