Individual
SHANTA GAUTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
725 HAMLINE ST - ALTRU FAMILY MEDICINE RESIDENCY, GRAND FORKS, ND 58203
(701) 780-6800
(781) 744-5358
Mailing address
2401 DEMERS AVE, GRAND FORKS, ND 58201
(701) 780-1891
(781) 744-5358
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11672
ND
Other
Enumeration date
03/13/2008
Last updated
03/05/2019
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