Individual
DR. PRASUNA GNANA DUBAGUNTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1805 HENNEPIN AVE N, GLENCOE, MN 55336-1416
(320) 864-3121
(320) 864-7887
Mailing address
1805 HENNEPIN AVE N, GLENCOE, MN 55336-1416
(320) 864-3121
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
055401
GA
207R00000X
Internal Medicine Physician
Primary
64422
MN
207R00000X
Internal Medicine Physician
N1617
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208812201
—
TX
01
—
8CF471
BCBS
TX
Enumeration date
07/04/2006
Last updated
11/24/2020
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