Healthcare Provider Details

I. General information

NPI: 1174798383
Provider Name (Legal Business Name): MADHU KANNAPIRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 08/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 OAKDALE AVE N SUITE 605
ROBBINSDALE MN
55422-2948
US

IV. Provider business mailing address

3366 OAKDALE AVE N SUITE 605
ROBBINSDALE MN
55422-2948
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-2940
  • Fax:
Mailing address:
  • Phone: 763-520-2940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number52469
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: