Provider Demographics
NPI:1881214641
Name:VICTOR, VAKAYIL ANTONY ROGER (MBBS)
Entity Type:Individual
Prefix:DR
First Name:VAKAYIL
Middle Name:ANTONY ROGER
Last Name:VICTOR
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:DR
Other - First Name:VICTOR
Other - Middle Name:ANTONY ROGER
Other - Last Name:VAKAYIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MBBS
Mailing Address - Street 1:420 DELAWARE STREET SE
Mailing Address - Street 2:MMC 195
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-6301
Mailing Address - Country:US
Mailing Address - Phone:612-624-4777
Mailing Address - Fax:
Practice Address - Street 1:420 DELAWARE STREET SE
Practice Address - Street 2:MMC 195
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-6301
Practice Address - Country:US
Practice Address - Phone:612-624-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program