Basic Information
| Provider Information | |||||||||
| NPI: | 1659785988 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TATINENI | ||||||||
| FirstName: | SUSHMA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 UNIVERSITY AVE W STE 110N | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551142001 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 910 E 26TH ST # 100-200 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554044526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128846300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2014 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01084146A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 4351042649 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 390200000X | 11017611A | IN | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RH0003X | 69531 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.