Basic Information
Provider Information | |||||||||
NPI: | 1952394694 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KEWALRAMANI | ||||||||
FirstName: | ASHOK | ||||||||
MiddleName: | C | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 233 W 1ST ST | ||||||||
Address2: |   | ||||||||
City: | WACONIA | ||||||||
State: | MN | ||||||||
PostalCode: | 553871302 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9524429770 | ||||||||
FaxNumber: | 9524423620 | ||||||||
Practice Location | |||||||||
Address1: | 2450 RIVERSIDE AVE | ||||||||
Address2: |   | ||||||||
City: | MINNEAPOLIS | ||||||||
State: | MN | ||||||||
PostalCode: | 554541400 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6126249903 | ||||||||
FaxNumber: | 6126262363 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/29/2005 | ||||||||
LastUpdateDate: | 05/21/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/21/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 3544 | AZ | N |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 207L00000X | 02465 | IA | N |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 207Q00000X | 02465 | IA | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207L00000X | 62802 | MN | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 30116 | 01 | IA | BLUE CROSS | OTHER | 0248484 | 05 | IA |   | MEDICAID |