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Individual

KAVYAMOL THYAGARAJAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
1835 CTY RD C, STE 150, ROSEVILLE, MN 55113-2723
(763) 581-0340
(763) 581-0346
Mailing address
611 W PARK ST, URBANA, IL 61801-2529

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125.072824
IL
207Q00000X
Family Medicine Physician
Primary
69960
MN

Other

Enumeration date
06/07/2018
Last updated
09/01/2021
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