Provider Demographics
NPI:1780120279
Name:POKWAL CHHETRI, TIL
Entity type:Individual
Prefix:
First Name:TIL
Middle Name:
Last Name:POKWAL CHHETRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1394 JACKSON ST
Mailing Address - Street 2:105
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-4629
Mailing Address - Country:US
Mailing Address - Phone:651-621-9019
Mailing Address - Fax:651-207-8436
Practice Address - Street 1:1394 JACKSON ST
Practice Address - Street 2:105
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-4629
Practice Address - Country:US
Practice Address - Phone:651-621-9019
Practice Address - Fax:651-207-8436
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health