Provider Demographics
NPI:1013984483
Name:MISHRA, ATUL K (MD)
Entity Type:Individual
Prefix:DR
First Name:ATUL
Middle Name:K
Last Name:MISHRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 CARLSON ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2626
Mailing Address - Country:US
Mailing Address - Phone:507-532-1101
Mailing Address - Fax:507-532-1137
Practice Address - Street 1:1420 EAST COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258
Practice Address - Country:US
Practice Address - Phone:507-532-9631
Practice Address - Fax:507-532-1176
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35763208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN573877600Medicaid
F31905Medicare UPIN
MN370002186Medicare ID - Type Unspecified