Healthcare Provider Details

I. General information

NPI: 1760172563
Provider Name (Legal Business Name): SANDIPKUMAR SEVANTIBHAI CHAUDHARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 BROADWAY NORTH
FARGO ND
58122-7927
US

IV. Provider business mailing address

801 BROADWAY NORTH
FARGO ND
58122-0170
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-6076
  • Fax: 701-234-7230
Mailing address:
  • Phone: 701-234-6076
  • Fax: 701-234-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37439
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRL19707
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: