Individual
SRIDEVI VASA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9055 SPRINGBROOK DR NW, COON RAPIDS, MN 55433-5841
(763) 236-8000
Mailing address
9055 SPRINGBROOK DRIVE, COON RAPIDS, MN 55433
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
58553
MN
207QA0505X
Adult Medicine Physician
58553
MN
Other
Enumeration date
04/10/2012
Last updated
11/10/2020
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