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General NPI Number Information
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NPI Number | 1063874881
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Entity Type | Individual
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Provider Name | VISHNUTEJA V DEVALLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 2024 S 6TH ST
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City | BRAINERD
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State | MN
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Zip | 56401-4529
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Country | US
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Telephone | 218-828-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 1740 LAKEVIEW DR
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City | DULUTH
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State | MN
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Zip | 55803-2548
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Country | US
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Telephone | 218-880-1115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 69257
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License Number State | MN
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