Individual
CHANDRA S GOTTIPATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS
Contact information
Practice address
1720 HIGHWAY 59 S, THIEF RIVER FALLS, MN 56701-4331
(218) 681-4747
Mailing address
1720 HIGHWAY 59 S, THIEF RIVER FALLS, MN 56701-4331
(218) 683-4600
(218) 681-8487
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
48897
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0127049
MEDICA
—
01
—
1050984
PREFERREDONE
—
05
—
14261
—
ND
01
—
28770
ND BCBS
ND
05
—
547652000
—
MN
01
—
HP80578
HEALTHPARTNERS
—
Enumeration date
01/18/2007
Last updated
01/19/2012
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