Healthcare Provider Details

I. General information

NPI: 1093746000
Provider Name (Legal Business Name): SALIMA MITHANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 FORD PKWY
SAINT PAUL MN
55116-1932
US

IV. Provider business mailing address

1021 BANDANA BLVD E SUITE 200
SAINT PAUL MN
55108-5113
US

V. Phone/Fax

Practice location:
  • Phone: 651-696-8800
  • Fax: 651-696-8880
Mailing address:
  • Phone: 651-642-2700
  • Fax: 651-642-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number44462
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: