Individual
SUNDARA C NALLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
229 SYLVAN DR, FAIRMONT, MN 56031-2421
(507) 749-0111
Mailing address
229 SYLVAN DR, FAIRMONT, MN 56031-2421
(507) 749-0111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32815
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080120227
RR MEDICARE
MN
01
—
0D930NA
BCBS MPIN
MN
01
—
115527
UCARE
FM
05
—
1967802
—
IA
05
—
950797300
—
MN
Enumeration date
10/02/2006
Last updated
11/30/2021
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