Healthcare Provider Details

I. General information

NPI: 1841652146
Provider Name (Legal Business Name): DEEPTHI CHANDRA MALEPATI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 DELAWARE STREET SE MAIL CODE 1932J
MINNEAPOLIS MN
55414
US

IV. Provider business mailing address

717 DELAWARE ST SE
MINNEAPOLIS MN
55414-2959
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-9444
  • Fax:
Mailing address:
  • Phone: 651-770-9451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number69635
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0116032602
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: