Individual
PREM NATH PATHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS
Contact information
Practice address
1800 E INTERSTATE AVE STE B, BISMARCK, ND 58503-1566
(701) 323-6543
(701) 323-5492
Mailing address
P.O. BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 328-6585
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
12788
ND
390200000X
Student in an Organized Health Care Education/Training Program
0116020790
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1451039
—
ND
Enumeration date
07/20/2009
Last updated
04/04/2022
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