Basic Information
| Provider Information | |||||||||
| NPI: | 1326165028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELSARE | ||||||||
| FirstName: | JAYANT | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 E 10TH ST | ||||||||
| Address2: | |||||||||
| City: | WACONIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553874552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524429770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 611 S ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 526412538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3199865651 | ||||||||
| FaxNumber: | 9524423630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 04/28/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 18760 | IA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.