Healthcare Provider Details

I. General information

NPI: 1932426004
Provider Name (Legal Business Name): VEENA R IYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 HWY 36 W. STE. 100
ROSEVILLE MN
55113
US

IV. Provider business mailing address

2355 HWY 36 W. STE. 100
ROSEVILLE MN
55113
US

V. Phone/Fax

Practice location:
  • Phone: 651-292-2000
  • Fax:
Mailing address:
  • Phone: 651-292-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number58955
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number58955
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: