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General NPI Number Information
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NPI Number | 1770635682
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Entity Type | Individual
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Provider Name | CHANDRA S GOTTIPATI MBBS
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Gender | Male
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 1720 HIGHWAY 59 S
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City | THIEF RIVER FALLS
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State | MN
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Zip | 56701-4331
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Country | US
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Telephone | 218-681-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 HIGHWAY 59 S
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City | THIEF RIVER FALLS
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State | MN
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Zip | 56701-4331
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Country | US
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Telephone | 218-683-4600
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Fax | 218-681-8487
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 48897
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License Number State | MN
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