Individual
SUPREET DESHPANDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 UNIVERSITY AVE E, SAINT PAUL, MN 55101-2507
(651) 291-2848
(651) 602-6885
Mailing address
200 UNIVERSITY AVE E, SAINT PAUL, MN 55101-2507
(651) 291-2848
(651) 602-6885
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
50394
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
250000773
MEDICARE PTAN
MN
Enumeration date
02/07/2008
Last updated
09/06/2019
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