Provider Demographics
NPI:1437183084
Name:GUPTA, SANDEEP TRILOKCHANDRA (MB, BS)
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:TRILOKCHANDRA
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MB, BS
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Other - First Name:
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Mailing Address - Street 1:6200 SHINGLE CREEK PKWY STE 260
Mailing Address - Street 2:KIDNEY SPECIALISTS OF MN
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2128
Mailing Address - Country:US
Mailing Address - Phone:763-561-5349
Mailing Address - Fax:
Practice Address - Street 1:6200 SHINGLE CREEK PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2128
Practice Address - Country:US
Practice Address - Phone:763-544-0696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN45546207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1040994OtherPREFERRED ONE
MNHP41105OtherHEALTHPARTNERS
MN131379OtherUCARE
MN31-00218OtherMEDICA CHOICE
MT0075072Medicaid
MN31-00005OtherMEDICA PRIMARY
MN398618700Medicaid
MN31-00005OtherMEDICA PRIMARY
MN131379OtherUCARE