PONRELIL PHILIPOSE PHILIP (NPI# 1750586517) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750586517 |
| Entity Type | Individual |
| Full Name | PONRELIL PHILIPOSE PHILIP |
| Credential | PHD |
| Practice Address |
103 North Broad Street Mankato MN 56001 |
| Practice Telephone | 5073455049 |
| Mailing Telephone | 5073455049 |
| Mailing Fax Number | 5073876577 |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
LP2258 | MN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | U CARE | 17311 | 01 |
| MN | BCBS | 41516PH | 01 |
| MN | BCBS | 89500PH | 01 |
| MN | U CARE | 135065 | 01 |
| Street Address |
103 NORTH BROAD STREET |
| City | MANKATO |
| State | MN |
| Zip Code | 56001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154935435 | Kelly Nicole Ricke | Physical Medicine & Rehabilitation | 1 Civic Center Plaza, Hockey Office Complex, Mankato, MN 56001 | 2020-09-03 |
| 1649816786 | Ashley Lynn Walters | Technician, Other | 501 Madison Ave., Mankato, MN 56001 | 2019-11-25 |
| 1720631716 | Dovetail Traslation LLC | Interpreter | 212 Dublin Ct, Same As Above, Mankato, MN 56001 | 2019-07-19 |
| 1093377871 | Lindsey Keithahn | Counselor | 2100 Bassett Drive, Mankato, MN 56001 | 2019-07-02 |
| 1255803813 | Amy Marie Williams | Acupuncturist | 709 S. Front Street, Suite 5, Mankato, MN 56001 | 2018-12-20 |
| 1518437573 | Ashley Blanchard | Acupuncturist | Vida Salon Suites 1351 Madison Avenue, Suite F/ Suite 206, Mankato, MN 56001 | 2018-12-03 |
| 1831687235 | Christian Goetz | Specialist/Technologist | 401-477 South Rd, Mankato, MN 56001 | 2018-05-01 |
| 1366949141 | Minnesota State College and Universities | Specialist/Technologist | 135 Myers Field House, Mankato, MN 56001 | 2018-04-09 |
| 1780191775 | Kevin David Nelson | Pharmacist | 111 Redtail Ct Apt 308, Mankato, MN 56001 | 2017-12-29 |
| 1972014231 | Rylee Wagner | Speech-Language Pathologist | Mankato Clinic Pediatric Therapy Services, 150 St. Andrews Court, Suite 310, Mankato, MN 56001 | 2017-10-13 |
| Find all providers in zip 56001 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417365057 | Adam Anderson, Phd, Clinical Psychologist, LLC | Psychologist | 11 Civic Center Plz Ste 201, Mankato, MN 56001-7718 | 2014-07-28 |
| 1124297213 | George V Komaridis | Psychologist | 12 Civic Center Plz, Suite 2090, Mankato, MN 56001-7781 | 2008-02-22 |
| 1326216169 | Philip Psychological Clinic | Psychologist | 510 Sibley Street, Suite 200, Mankato, MN 56001 | 2008-02-14 |
| 1235273624 | Jacquelyn Marie Jauss | Psychologist | 11 Civic Center Plz, Suite 201, Mankato, MN 56001-7710 | 2007-02-18 |
| 1093886673 | David Earl Hildebrandt | Psychologist | 100 Martin Luther King Dr, Mankato, MN 56001-6275 | 2006-11-13 |
| 1912938275 | Eric Sprankle | Psychologist | 1600 Warren St, Suite 6, Mankato, MN 56001-5197 | 2006-07-05 |
| 1063463347 | Theodore Surdy | Psychologist | 1207 Caledonia St, Mankato, MN 56001-4329 | 2006-05-12 |
| 1043298060 | Theresa L Gunderson | Psychologist | Madison East Center, Suite 352 Mankato Clinic Department of Psychiatry, Mankato, MN 56001 | 2006-01-09 |
| 1932106606 | Kathleen Christensen | Psychologist | 1400 Madison Ave Ste 628, Mankato, MN 56001-5488 | 2005-07-07 |
| 1104394212 | Tyler Maxwell Dority | Psychologist | 12 Civic Center Plz Ste 1615, Mankato, MN 56001-7783 | 2018-11-06 |
| Find all providers in MANKATO | ||||
Please comment or provide details below to improve the information on PONRELIL PHILIPOSE PHILIP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.