Basic Information
| Provider Information | |||||||||
| NPI: | 1124113352 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VEGE | ||||||||
| FirstName: | KANAKA DURGA | ||||||||
| MiddleName: | SWAROOP | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 4TH ST SE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559044717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5075296616 | ||||||||
| FaxNumber: | 5075296622 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 4TH ST SE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559044717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5075296616 | ||||||||
| FaxNumber: | 5075296622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 03/18/2014 | ||||||||
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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 | 207ZB0001X | 44126 | MN | N | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZP0102X | 44126 | MN | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0105X | 44126 | MN | N | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
ID Information
| ID | Type | State | Issuer | Description | 584S3VE | 01 | MN | BCBS | OTHER | 231003100 | 05 | MN | MEDICAID | 34390900 | 05 | WI | MEDICAID |