Healthcare Provider Details

I. General information

NPI: 1114817384
Provider Name (Legal Business Name): SANJEEV AHILAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 11TH AVE SW
MINOT ND
58701-4207
US

IV. Provider business mailing address

1201 11TH AVE SW
MINOT ND
58701-4207
US

V. Phone/Fax

Practice location:
  • Phone: 701-858-6700
  • Fax: 701-858-6736
Mailing address:
  • Phone: 701-858-6700
  • Fax: 701-858-6736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRL22662
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: