Provider Demographics
NPI:1710079645
Name:KANDASWAMY, RAJA (MD)
Entity Type:Individual
Prefix:
First Name:RAJA
Middle Name:
Last Name:KANDASWAMY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:720 WASHINGTON AVE SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414
Mailing Address - Country:US
Mailing Address - Phone:612-884-0649
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE STREET SE, PWB SECOND FLOOR, CLINIC 2A
Practice Address - Street 2:UMP TRANSPLANT & MEDICINE SPECIALTIES
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-884-0649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN40288208600000X
FLME109323208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN114108OtherFAIRVIEW
MN1707564OtherMEDICA-CHOICE
MN9G695KAOtherBCBS
MNHP28837OtherHEALTH PARTNERS
MN122137OtherU CARE
MN1018634OtherPREFERRED ONE
WI32401700Medicaid
FL003387700Medicaid
MN17-00026OtherMEDICA-PRIMARY
MN806818600Medicaid
IA0542290Medicaid
914563OtherARAZ
MN17-00026OtherMEDICA-PRIMARY
MNHP28837OtherHEALTH PARTNERS
G88133Medicare UPIN