Individual
POONAM RAJE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MBBS
Contact information
Practice address
9900 TAMARACK RD, WOODBURY, MN 55125-3609
(651) 471-5800
Mailing address
10153 BRIDGEWATER COURT, WOODBURY, MN 55129
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
45287
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
398602100
—
MN
Enumeration date
02/21/2006
Last updated
03/17/2018
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