Provider Demographics
NPI:1063444669
Name:KANWAR, MANPREET (MD)
Entity Type:Individual
Prefix:
First Name:MANPREET
Middle Name:
Last Name:KANWAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANPREET
Other - Middle Name:
Other - Last Name:SANDHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8674
Mailing Address - Street 2:1230 E MAIN ST MANKATO CLINIC LTD
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1230 E MAIN ST
Practice Address - Street 2:MANKATO CLINIC
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56002-8674
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48657207R00000X, 207RC0000X
MI4301076854207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1063444669Medicaid
P00374307OtherRR MEDICARE
MN135977OtherUCARE
MN2444527OtherAMERICAS PPO
MN2502186OtherMEDICA
41084933956001C239OtherCHAMPUS
MN839447000Medicaid
MNHP70702OtherHEALTH PARTNERS
MNNA2951048668OtherPREFERRED ONE
MNHP58504OtherHEALTH PARTNERS
MN448L7KAOtherBCBS