Individual
DR. SARASWATHY NONESUPPLIED MANICKAVASAGAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MBBS
Contact information
Practice address
3000 32ND AVE S, FARGO, ND 58103-6132
(701) 364-8000
(701) 364-8078
Mailing address
400 EAST THIRD STREET, DULUTH, MN 55805-1951
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
13092
ND
207RC0000X
Cardiovascular Disease Physician
13092
ND
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
13092
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457007
—
ND
01
—
3858509476
MYUTMB 3858509476-COMMERCIAL NUMBER
—
Enumeration date
06/14/2007
Last updated
05/14/2019
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