Provider Demographics
NPI:1215317193
Name:KAMBALE, NEETI (DO)
Entity type:Individual
Prefix:DR
First Name:NEETI
Middle Name:
Last Name:KAMBALE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14701 VICTOR HUGO BLVD N
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-4561
Mailing Address - Country:US
Mailing Address - Phone:651-426-1141
Mailing Address - Fax:651-426-1705
Practice Address - Street 1:14701 VICTOR HUGO BLVD N
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038
Practice Address - Country:US
Practice Address - Phone:651-426-1141
Practice Address - Fax:651-426-1705
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN64113208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics