Provider Demographics
NPI:1508480716
Name:SUBEDI, IMONA (MBBS)
Entity type:Individual
Prefix:
First Name:IMONA
Middle Name:
Last Name:SUBEDI
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-5181
Mailing Address - Country:US
Mailing Address - Phone:154-230-1227
Mailing Address - Fax:158-431-1767
Practice Address - Street 1:5409 VERN HOLMES DR
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8853
Practice Address - Country:US
Practice Address - Phone:715-344-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2025-08-23
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-03-17
Provider Licenses
StateLicense IDTaxonomies
WI85534-20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine