1447254123 NPI number — DR. SHOBANA MURALI M.D.

Table of content: DR. SHOBANA MURALI M.D. (NPI 1447254123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447254123 NPI number — DR. SHOBANA MURALI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURALI
Provider First Name:
SHOBANA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447254123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 NICOLLET MALL
Provider Second Line Business Mailing Address:
STE 2000
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55402-2708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-338-4861
Provider Business Mailing Address Fax Number:
612-333-8306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 STINSON BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55421-3488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-788-1621
Provider Business Practice Location Address Fax Number:
612-788-8079
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  40582 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0812378 . This is a "SELECTCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: G92861 . This is a "PATIENT CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP27732 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 63D75MU . This is a "BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 200002101436 . This is a "METROPOLITAN HEALTH PLAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01020475 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0800038 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0812378 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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