Individual
DR. SRINIVASA REDDY VAKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
FAIRVIEW CLINICS-BASS LAKE, 6320 WEDGWOOD RD N, MAPLE GROVE, MN 55311-3647
(763) 268-0400
(763) 268-0405
Mailing address
FAIRVIEW CLINICS-BASS LAKE, 6320 WEDGWOOD RD N, MAPLE GROVE, MN 55311-3647
(763) 268-0400
(763) 268-0405
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
65117
MN
207R00000X
Internal Medicine Physician
E7137
AR
208M00000X
Hospitalist Physician
E7137
AR
Other
Enumeration date
02/17/2009
Last updated
09/23/2019
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