Organization
VALLEY MEDICAL CLINIC PC
Active
Other names
Valley Internal Medicine Assoc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PANJINI M SIVANNA M.D. (PRESIDENT)
(701) 297-0817
Entity
Organization
Contact information
Practice address
300 MAIN AVE, STE 200, FARGO, ND 58103-1930
(701) 297-0817
(701) 297-6870
Mailing address
300 MAIN AVE, STE 200, FARGO, ND 58103-1930
(701) 297-0817
(701) 297-6870
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
4806
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11224
—
ND
Enumeration date
08/19/2006
Last updated
04/02/2015
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