Healthcare Provider Details

I. General information

NPI: 1891614376
Provider Name (Legal Business Name): SAI AMRUTH BOPPE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SANDFORD HEALTH 5225 23RD AVE S
FARGO ND
58104
US

IV. Provider business mailing address

SANDFORD HEALTH 5225 23RD AVE S
FARGO ND
58104
US

V. Phone/Fax

Practice location:
  • Phone: 701-417-1333
  • Fax:
Mailing address:
  • Phone: 701-417-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberRL24423
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: