Basic Information
| Provider Information | |||||||||
| NPI: | 1063444669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANWAR | ||||||||
| FirstName: | MANPREET | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SANDHU | ||||||||
| OtherFirstName: | MANPREET | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 8674 | ||||||||
| Address2: | 1230 E MAIN ST MANKATO CLINIC LTD | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560028674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1230 E MAIN ST | ||||||||
| Address2: | MANKATO CLINIC | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560028674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 07/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 48657 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 4301076854 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 48657 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1063444669 | 05 | IA | MEDICAID | P00374307 | 01 | RR MEDICARE | OTHER | 135977 | 01 | MN | UCARE | OTHER | 2444527 | 01 | MN | AMERICAS PPO | OTHER | 2502186 | 01 | MN | MEDICA | OTHER | 41084933956001C239 | 01 | CHAMPUS | OTHER | 839447000 | 05 | MN | MEDICAID | HP70702 | 01 | MN | HEALTH PARTNERS | OTHER | NA2951048668 | 01 | MN | PREFERRED ONE | OTHER | HP58504 | 01 | MN | HEALTH PARTNERS | OTHER | 448L7KA | 01 | MN | BCBS | OTHER |