# VEIN CLINIC PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457667784
- **Authorized official:** DR. SAMEER GUPTA MD (CEO/PRESIDENT)
- **Authorized official phone:** (952) 934-3296

## Contact information

- **Practice address:** 16372 KENRICK AVE, SUITE 100, LAKEVILLE, MN 55044-3540
- **Practice address phone:** (952) 892-1222
- **Practice address fax:** (952) 892-1221
- **Mailing address:** 470 W 78TH ST, STE. 250, CHANHASSEN, MN 55317-4524
- **Mailing address phone:** (952) 934-3296
- **Mailing address fax:** (952) 906-1737

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/24/2010
- **Last updated:** 01/02/2013