Provider Demographics
NPI:1467596148
Name:KAVATHEKAR, POORNIMA K (MD)
Entity Type:Individual
Prefix:DR
First Name:POORNIMA
Middle Name:K
Last Name:KAVATHEKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:POORNIMA
Other - Middle Name:KAMRAN
Other - Last Name:KAVATHEKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-641-6200
Mailing Address - Fax:
Practice Address - Street 1:2500 COMO AVENUE
Practice Address - Street 2:MAIL STOP 31100A - HEALTHPARTNERS COMO CLINIC
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1460
Practice Address - Country:US
Practice Address - Phone:651-641-6200
Practice Address - Fax:651-641-6205
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49320208000000X
NHT0273208000000X
NH13674208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics