Basic Information
| Provider Information | |||||||||
| NPI: | 1093746000 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MITHANI | ||||||||
| FirstName: | SALIMA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1021 BANDANA BLVD E | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551085113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516422700 | ||||||||
| FaxNumber: | 6516429441 | ||||||||
| Practice Location | |||||||||
| Address1: | 2005 FORD PKWY | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551161932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516968800 | ||||||||
| FaxNumber: | 6516968880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 44462 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 92943500 | 05 | MN | MEDICAID |