Individual
TANVEER-E-FATEMA ROSHANALI HASSAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2200 NW 26TH ST, OWATONNA, MN 55060-5503
(451) 112-0507
Mailing address
2200 NW 26TH ST, OWATONNA, MN 55060-5503
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
64533
MN
208M00000X
Hospitalist Physician
Primary
64533
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/27/2014
Last updated
04/08/2022
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