Provider Demographics
NPI:1740207745
Name:CHEMITI, GOPAL KRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:GOPAL
Middle Name:KRISHNA
Last Name:CHEMITI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:801 BROADWAY N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-3641
Mailing Address - Country:US
Mailing Address - Phone:701-234-3360
Mailing Address - Fax:701-234-3868
Practice Address - Street 1:5169 S COTTONWOOD ST STE 320
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-6768
Practice Address - Country:US
Practice Address - Phone:801-507-2531
Practice Address - Fax:701-234-3868
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT113513368905207RN0300X
ND9408207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12913Medicaid
NDN23935Medicare PIN
ND12913Medicaid
MN390000540Medicare PIN
MN390000486Medicare PIN
H98277Medicare UPIN