Healthcare Provider Details

I. General information

NPI: 1063711497
Provider Name (Legal Business Name): MITHULAN JEGAPRAGASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MITH JEGAPRAGASAN NICKNAME

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

IV. Provider business mailing address

501 E HAMPDEN AVE
ENGLEWOOD CO
80113-2702
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number58365
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberML60225427
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number58365
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0064418
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: