MEDICARE: DR. SANDEEP TRILOKCHANDRA GUPTA M.B., B.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	45546	MN
2	207RN0300X	Nephrology Physician	45546	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1040994	OTHER	MN	PREFERRED ONE
2	HP41105	OTHER	MN	HEALTHPARTNERS
3	131379	OTHER	MN	UCARE
4	31-00218	OTHER	MN	MEDICA CHOICE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	31-00005	OTHER	MN	MEDICA PRIMARY
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437183084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDEEP TRILOKCHANDRA GUPTA M.B., B.S.

Provider Business Mailing Address
First Line	:	6200 SHINGLE CREEK PKWY STE 260
Second Line	:	KIDNEY SPECIALISTS OF MN
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-2128
Country	:	US
Telephone Number	:	763-561-5349
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 SHINGLE CREEK PKWY
Second Line	:	SUITE 250
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-2128
Country	:	US
Telephone Number	:	763-544-0696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	11/10/2020

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