=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942697784
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IMINDER KAUR SARAN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2015
-----------------------------------------------------
Last Update Date | 10/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ALLINA HEALTH MENTAL HEALTH - MERCY HOSPITAL UNITY CAM 480 OSBORNE RD NE STE 260
-----------------------------------------------------
City | FRIDLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55432-2866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-236-3800
-----------------------------------------------------
Fax | 763-236-3821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 ARLINGTON AVE MS 1050, GRADUATE MEDICAL EDUCATION
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43614-2595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-383-5674
-----------------------------------------------------
Fax | 419-383-2959
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 66158
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------