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General NPI Number Information
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NPI Number | 1720184849
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Entity Type | Individual
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Provider Name | SRINIVASAN RAMANUJA M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 1421 PREMIER DR MANKATO CLINIC WICKERSHAM
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City | MANKATO
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State | MN
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Zip | 56001
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Country | US
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Telephone | 507-625-1811
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8674 1230 E MAIN ST MANKATO CLINIC LTD
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City | MANKATO
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State | MN
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Zip | 56001
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Country | US
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Telephone | 507-625-1811
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | A88016
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 49842
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License Number State | MN
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