Provider Demographics
NPI:1629357199
Name:VEIN CLINIC PA
Entity Type:Organization
Organization Name:VEIN CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-641-4472
Mailing Address - Street 1:2801 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2125
Mailing Address - Country:US
Mailing Address - Phone:218-454-0095
Mailing Address - Fax:952-934-5728
Practice Address - Street 1:13954 CYPRESS DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8810
Practice Address - Country:US
Practice Address - Phone:218-316-3001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46358174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty