Provider Demographics
NPI:1649451873
Name:CHANGARATH VIJAYAN, ANIL KUMAR (MBBS)
Entity type:Individual
Prefix:
First Name:ANIL KUMAR
Middle Name:
Last Name:CHANGARATH VIJAYAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 6TH AVENUE NORTH
Mailing Address - Street 2:CENTRACARE CLINIC RIVER CAMPUS
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-240-2207
Mailing Address - Fax:320-240-7896
Practice Address - Street 1:1200 6TH AVENUE NORTH
Practice Address - Street 2:CENTRACARE CLINIC RIVER CAMPUS
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-240-2207
Practice Address - Fax:320-240-7896
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN60177207R00000X, 207RC0200X, 207RP1001X
OH35.121030207R00000X, 207RC0200X, 207RP1001X
IL036.125622207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine