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General NPI Number Information
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NPI Number | 1134566276
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Entity Type | Individual
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Provider Name | AJIT INDAVARAPU MD
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Gender | Male
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 701 PARK AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55415
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Country | US
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Telephone | 612-873-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 S CLARK ST UNIT 1215
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City | CHICAGO
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State | IL
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Zip | 60605-2193
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Country | US
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Telephone | 732-979-6875
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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 | 2084A2900X
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Taxonomy Name | Neurocritical Care Physician
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License Number | 64016
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 036-141142
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License Number State | IL
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