Individual
DR. BHASKAR CHANDU KOLLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-3448
Mailing address
8170 33RD AVE S, MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125050705
IL
207R00000X
Internal Medicine Physician
53546
WI
207RH0003X
Hematology & Oncology Physician
Primary
56191
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659535615
—
WI
Enumeration date
07/17/2008
Last updated
04/17/2024
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