Provider Demographics
NPI:1588814016
Name:KANUGA, MANSI JAYESH (MD,)
Entity Type:Individual
Prefix:DR
First Name:MANSI
Middle Name:JAYESH
Last Name:KANUGA
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 HEWITT BLVD
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2848
Mailing Address - Country:US
Mailing Address - Phone:651-267-5000
Mailing Address - Fax:651-267-5910
Practice Address - Street 1:701 HEWITT BLVD
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2848
Practice Address - Country:US
Practice Address - Phone:651-267-5000
Practice Address - Fax:651-267-5910
Is Sole Proprietor?:No
Enumeration Date:2008-09-20
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08452300207K00000X
RIMD13231207R00000X
MN54148207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGROUP NPI 1538161161OtherRI BS
RI36799OtherNEIGHBORHOOD HEALTH
RINPI 1588814016OtherRI BS
RI298399OtherUS FAMILY
MN1588814016Medicaid
RIAA175128OtherHARVARD PILGRIM
RIMK79545Medicaid
RI756565OtherTUFTS
RIMK79545Medicaid