Provider Demographics
NPI:1134191869
Name:MENON, KOZHIKODE VEETIL NARAYANAN (MD, MB, BS)
Entity type:Individual
Prefix:
First Name:KOZHIKODE VEETIL
Middle Name:NARAYANAN
Last Name:MENON
Suffix:
Gender:M
Credentials:MD, MB, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-8535
Mailing Address - Fax:605-322-8536
Practice Address - Street 1:1001 E 21ST ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1033
Practice Address - Country:US
Practice Address - Phone:605-322-8535
Practice Address - Fax:605-322-8536
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43331207RG0100X
SD7010207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDC70501051883OtherPREFERRED ONE
MN8G872MEOtherCC SYSTEMS/ BLUE PLUS
SD2900749OtherMEDICA
SD57105N004OtherWPS TRICARE
SDHP31651OtherHEALTHPARTNERS
SD4992979OtherBLUE CROSS
SD6631900Medicaid
1134191869OtherARAZ/AMERICA'S PPO
IA1134191869Medicaid
MN751117500Medicaid
NE10025567100Medicaid
SD7010OtherDAKOTACARE
SD253800OtherMIDLANDS CHOICE
MN8G872MEOtherBLUE CROSS
SD4992979OtherBLUE CROSS
H26378Medicare UPIN