Provider Demographics
NPI:1952394694
Name:KEWALRAMANI, ASHOK C (DO)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:C
Last Name:KEWALRAMANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1302
Mailing Address - Country:US
Mailing Address - Phone:952-442-9770
Mailing Address - Fax:952-442-3620
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1400
Practice Address - Country:US
Practice Address - Phone:612-624-9903
Practice Address - Fax:612-626-2363
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3544207L00000X
IA02465207L00000X, 207Q00000X
MN62802207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA30116OtherBLUE CROSS
IA0248484Medicaid
IA30116OtherBLUE CROSS
IAI4969Medicare ID - Type Unspecified