Organization
VEIN CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMEER GUPTA MD (CEO/PRESIDENT)
(952) 934-3296
Entity
Organization
Contact information
Practice address
16372 KENRICK AVE, SUITE 100, LAKEVILLE, MN 55044-3540
(952) 892-1222
(952) 892-1221
Mailing address
470 W 78TH ST, STE. 250, CHANHASSEN, MN 55317-4524
(952) 934-3296
(952) 906-1737
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C05399
MEDICARE PTAN
MN
Enumeration date
08/24/2010
Last updated
01/02/2013
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