Provider Demographics
NPI:1780786665
Name:DESHPANDE, SANJAY S (MD)
Entity type:Individual
Prefix:
First Name:SANJAY
Middle Name:S
Last Name:DESHPANDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2193
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:915 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2193
Practice Address - Country:US
Practice Address - Phone:414-298-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31209-020207RC0001X
MN69737207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31768100OtherNETWORK HEALTH T19
31768100OtherMANAGED HEALTH SERVICES
WI31768100OtherINDEPENDENT CARE
WI31768100Medicaid
P00061095OtherMEDICARE RR PIN
31768100OtherABRI HEALTHCARE T19
4455639OtherAETNA
2263828OtherCIGNA
31768100OtherAMERICHOICE T19
WI31768100OtherNETWORK HEALTH T19
31768100OtherAMERICHOICE T19
P00752588Medicare PIN
E36357Medicare UPIN
000060295-0001Medicare ID - Type UnspecifiedSHEBOY & OSHKOSH COUNTIES
4455639OtherAETNA
WI31768100Medicaid
000002525-0353Medicare PIN