Basic Information
| Provider Information | |||||||||
| NPI: | 1720184849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAMANUJA | ||||||||
| FirstName: | SRINIVASAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8674 | ||||||||
| Address2: | 1230 E MAIN ST MANKATO CLINIC LTD | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1421 PREMIER DR | ||||||||
| Address2: | MANKATO CLINIC WICKERSHAM | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 07/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | A88016 | CA | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207K00000X | 49842 | MN | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | HP83054 | 01 | MN | HEALTH PARTNERS | OTHER | 168109 | 01 | MN | UCARE | OTHER | 236D3RA | 01 | MN | BCBS | OTHER | 854903000 | 05 | MN | MEDICAID | NA2951051979 | 01 | MN | PREFERRED ONE | OTHER | 1720184849 | 01 | MN | AMERICA'S PPO | OTHER |