MEDICARE: SNIGDHASMRITHI SAGAR PUSALAVIDYASAGAR MBBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	43341	MN
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	43341	MN

General Provider Information

NPI Number	:	1033199955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SNIGDHASMRITHI SAGAR PUSALAVIDYASAGAR MBBS

Provider Business Mailing Address
First Line	:	420 DELAWARE ST SE
Second Line	:	MMC 276
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55455-0341
Country	:	US
Telephone Number	:	612-624-0999
Fax Number	:	612-625-2174

Provider Business Practice Location Address
First Line	:	606 24TH AVE S
Second Line	:	SUITE 106
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-1455
Country	:	US
Telephone Number	:	612-273-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	05/22/2014

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