Healthcare Provider Details

I. General information

NPI: 1538656921
Provider Name (Legal Business Name): BISWARAJ THARU MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date: 11/28/2018
Reactivation Date: 12/05/2018

III. Provider practice location address

3838 12TH AVE N
FARGO ND
58102-2931
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number20073
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number35.140521
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number69407
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.246410
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number200073
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: