Healthcare Provider Details

I. General information

NPI: 1205809191
Provider Name (Legal Business Name): JANANI KAMESAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANANI THEVARAJAN M.D.

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 COVINGTON CIR
STATEN ISLAND NY
10312-1175
US

IV. Provider business mailing address

11995 SINGLETREE LN STE 500
EDEN PRAIRIE MN
55344-5347
US

V. Phone/Fax

Practice location:
  • Phone: 952-595-1100
  • Fax: 612-294-4903
Mailing address:
  • Phone: 952-595-1301
  • Fax: 612-294-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number230465
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number230465
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number230465
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: