Healthcare Provider Details

I. General information

NPI: 1225773625
Provider Name (Legal Business Name): SANJANA BUKKAPATNAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 OAKDALE AVE N
ROBBINSDALE MN
55422-2926
US

IV. Provider business mailing address

240 PARK AVE UNIT 1403
MINNEAPOLIS MN
55415-2264
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-5200
  • Fax:
Mailing address:
  • Phone: 720-261-3786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number81754
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: