Healthcare Provider Details

I. General information

NPI: 1811981079
Provider Name (Legal Business Name): YASHODA T.R. RAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 SAINT FRANCIS AVE ST FRANCIS RADIATION THERAPY CTR
SHAKOPEE MN
55379-3301
US

IV. Provider business mailing address

6950 FRANCE AVE S MPLS RADIATION ONCOLOGY
EDINA MN
55435-2025
US

V. Phone/Fax

Practice location:
  • Phone: 952-403-2031
  • Fax: 952-403-2710
Mailing address:
  • Phone: 952-920-4915
  • Fax: 952-915-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number21308
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: