Healthcare Provider Details

I. General information

NPI: 1972092492
Provider Name (Legal Business Name): ARDIANA VULJAJ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST
SAINT PAUL MN
55101-2502
US

IV. Provider business mailing address

420 DELAWARE STREET SE MMC 284
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 952-967-7977
  • Fax: 651-254-9673
Mailing address:
  • Phone: 612-626-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number67962
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: