Healthcare Provider Details

I. General information

NPI: 1124087358
Provider Name (Legal Business Name): ANUDEEP K RAHIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VILLAGE CENTER DR
NORTH OAKS MN
55127-7848
US

IV. Provider business mailing address

400 VILLAGE CENTER DR
NORTH OAKS MN
55127-7848
US

V. Phone/Fax

Practice location:
  • Phone: 651-789-9800
  • Fax: 651-789-9810
Mailing address:
  • Phone: 651-789-9800
  • Fax: 651-789-9810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number50109
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: