Provider Demographics
NPI:1740217330
Name:DAS, GLADWIN SUSEEKAR (MB, BS)
Entity Type:Individual
Prefix:DR
First Name:GLADWIN
Middle Name:SUSEEKAR
Last Name:DAS
Suffix:
Gender:M
Credentials:MB, BS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 508
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-7924
Mailing Address - Fax:612-626-4411
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE STREET SE, PWB THIRD FLOOR, CLINIC 3B
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35192207R00000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN108605OtherUCARE
MN598508OtherARAZ
MN865524300Medicaid
MN25-00294OtherMEDICA CHOICE
MNHP22035OtherHEALTHPARTNERS
MN1009081OtherPREFERRED ONE
MN25-74659OtherMEDICA PRIMARY
MN8T849DAOtherBCBS
MN25-00294OtherMEDICA CHOICE
MN060000662Medicare ID - Type UnspecifiedMN MEDICARE
MN108605OtherUCARE