Healthcare Provider Details

I. General information

NPI: 1114173259
Provider Name (Legal Business Name): KRUTI TRIPATHI SHUKLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRUTI HARSHAVARDHAN TRIPATHI M.D.

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 MARKET PTE DR STE 100
BLOOMINGTON MN
55435-5435
US

IV. Provider business mailing address

7213 FLEETWOOD DR
EDINA MN
55439-1811
US

V. Phone/Fax

Practice location:
  • Phone: 952-767-4574
  • Fax:
Mailing address:
  • Phone: 914-299-1474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number54259
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: