Healthcare Provider Details

I. General information

NPI: 1982915492
Provider Name (Legal Business Name): GATI NIRANJAN DHROOVE MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRACARE CLINIC RIVER CAMPUS 1200 6TH AVENUE NORTH
ST CLOUD MN
56303-2735
US

IV. Provider business mailing address

CENTRACARE CLINIC RIVER CAMPUS 1200 6TH AVENUE NORTH
ST CLOUD MN
56303-2735
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-5131
  • Fax: 320-240-2146
Mailing address:
  • Phone: 320-252-5131
  • Fax: 320-240-2146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number40685
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number63637
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: