Organization
VEIN CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMEER GUPTQA MD (PRESIDENT/CEO)
(952) 934-3296
Entity
Organization
Contact information
Practice address
2801 WAYZATA BLVD, MINNEAPOLIS, MN 55405-2138
(952) 934-3296
(888) 389-5033
Mailing address
2801 WAYZATA BLVD, MINNEAPOLIS, MN 55405-2138
(952) 934-3296
(888) 389-5033
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1759
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200523130
—
MN
05
—
C05399
—
MN
Enumeration date
08/31/2012
Last updated
08/31/2012
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