Individual
MRS. JYOTHI BHANU KESHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
500 OSBORNE RD NE, SUITE 240, FRIDLEY, MN 55432-2765
(763) 783-8582
(763) 783-8616
Mailing address
2550 UNIVERSITY AVE W, SUITE 240N, SAINT PAUL, MN 55114-1052
(651) 999-6909
(651) 297-6115
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
42668
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307127800
—
MN
Enumeration date
10/03/2005
Last updated
10/13/2011
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