Individual
PRASUN MANDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
424 W HIGHWAY 5, WACONIA, MN 55387-1795
(952) 442-4461
Mailing address
384 BRICKYARD DR, CHASKA, MN 55318-2403
(409) 651-6504
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
79925
MN
207Q00000X
Family Medicine Physician
R-12405
IA
208600000X
Surgery Physician
5151015341
MI
Other
Enumeration date
06/18/2021
Last updated
05/22/2025
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