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1508842048

NPI Code Detail

MEDICARE: DR. THENAPPAN THENAPPAN MD

MEDICARE: DR. THENAPPAN THENAPPAN MD

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	106863	MN
2	207R00000X	Internal Medicine Physician	200500494	NC
3	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	57117	MN
4	207RC0000X	Cardiovascular Disease Physician	57117	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	139T4	OTHER	NC	BCBS NC

General Provider Information

NPI Number	:	1508842048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THENAPPAN THENAPPAN MD

Provider Business Mailing Address
First Line	:	1850 W ARLINGTON BLVD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5704
Country	:	US
Telephone Number	:	252-752-6101
Fax Number	:	252-752-6600

Provider Business Practice Location Address
First Line	:	909 FULTON ST SE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55455-4800
Country	:	US
Telephone Number	:	612-672-7422
Fax Number	:

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	06/17/2025

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Directions to “ DR. THENAPPAN THENAPPAN MD” Practice Location

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