Individual
DR. VENKAT KIRAN KANCHUSTAMBHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M/D
Contact information
Practice address
801, BROADWAY N, FARGO, ND 58102
(701) 234-2000
(701) 234-2345
Mailing address
801, BROADWAY N, FARGO, ND 58102
(701) 234-2000
(701) 234-2345
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
14482
ND
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/23/2010
Last updated
07/21/2022
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