Basic Information
Provider Information
NPI: 1912232125
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DAS
FirstName: SUBHRALEENA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.B.B.S
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1025 MARSH ST
Address2:  
City: MANKATO
State: MN
PostalCode: 560014752
CountryCode: US
TelephoneNumber: 5073894700
FaxNumber:  
Practice Location
Address1: 1025 MARSH ST
Address2:  
City: MANKATO
State: MN
PostalCode: 560014752
CountryCode: US
TelephoneNumber: 5077205805
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/05/2009
LastUpdateDate: 10/07/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/07/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0200X58743MNY Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine

No ID Information.


Home