Provider Demographics
NPI:1699202028
Name:JASWA, AMAR SAILESH (DO)
Entity Type:Individual
Prefix:
First Name:AMAR
Middle Name:SAILESH
Last Name:JASWA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2107
Mailing Address - Country:US
Mailing Address - Phone:218-249-5555
Mailing Address - Fax:218-249-5750
Practice Address - Street 1:915 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2107
Practice Address - Country:US
Practice Address - Phone:218-249-5555
Practice Address - Fax:218-249-5750
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151010640390200000X
MI5101025933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program