Basic Information
| Provider Information | |||||||||
| NPI: | 1134367352 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DHAM | ||||||||
| FirstName: | SHAILLY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3366 OAKDALE AVE NO | ||||||||
| Address2: | #315 NORTH CLINIC, PA | ||||||||
| City: | ROBBINSDALE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554222948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635877900 | ||||||||
| FaxNumber: | 7635877989 | ||||||||
| Practice Location | |||||||||
| Address1: | MAYO CLINIC HEALTH SYSTEM MANKATO | ||||||||
| Address2: | 1025 MARSH ST | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076254031 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2009 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 104501 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.