Basic Information
| Provider Information | |||||||||
| NPI: | 1376863274 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAMLE | ||||||||
| FirstName: | ANEEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3433 BROADWAY ST NE STE 115 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554131759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513121505 | ||||||||
| FaxNumber: | 6122482944 | ||||||||
| Practice Location | |||||||||
| Address1: | 1983 SLOAN PL STE 11 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551172004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513121620 | ||||||||
| FaxNumber: | 6513121570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2010 | ||||||||
| LastUpdateDate: | 08/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2018031091 | MO | N | Allopathic & Osteopathic Physicians | Surgery | 208C00000X | 2018031091 | MO | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208C00000X | 66219 | MN | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
No ID Information.