Provider Demographics
NPI:1063711497
Name:JEGAPRAGASAN, MITHULAN (MD)
Entity type:Individual
Prefix:DR
First Name:MITHULAN
Middle Name:
Last Name:JEGAPRAGASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MITH
Other - Middle Name:
Other - Last Name:JEGAPRAGASAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NICKNAME
Mailing Address - Street 1:501 E HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58365207R00000X, 208M00000X
WAML60225427207X00000X
CODR.0064418208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029134OtherKAISER COMMERCIAL NUMBER