Provider Demographics
NPI:1194704486
Name:GUNARATNAM, NARESH T (MD)
Entity type:Individual
Prefix:
First Name:NARESH
Middle Name:T
Last Name:GUNARATNAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14909
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-0909
Mailing Address - Country:US
Mailing Address - Phone:612-871-1145
Mailing Address - Fax:612-870-5491
Practice Address - Street 1:1185 TOWN CENTRE DR STE 205
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1370
Practice Address - Country:US
Practice Address - Phone:612-871-1145
Practice Address - Fax:612-870-5491
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI066308207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H14989OtherBCBS GROUP
MI8827203OtherCIGNA
MI0812773OtherBCBS INDIVIDUAL
MI100013737OtherMEDICARE RAILROAD PTAN
MI7427167OtherAETNA
MI4110501Medicaid
MI016711OtherMIDWEST HEALTH PLAN
MI8827203OtherCIGNA
MI4110501Medicaid
MI0M86730008Medicare PIN