1942246053 NPI number — SUPREET BUDHRAJA KATHPALIA MS.OTR L

Table of content: SUPREET BUDHRAJA KATHPALIA MS.OTR L (NPI 1942246053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942246053 NPI number — SUPREET BUDHRAJA KATHPALIA MS.OTR L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KATHPALIA
Provider First Name:
SUPREET
Provider Middle Name:
BUDHRAJA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS.OTR L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942246053
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 COBBLESTONE LANE
Provider Second Line Business Mailing Address:
COURAGE BURNSVILLE
Provider Business Mailing Address City Name:
BURNSVILLE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-898-5700
Provider Business Mailing Address Fax Number:
952-898-5757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 COBBLESTONE LANE
Provider Second Line Business Practice Location Address:
COURAGE BURNSVILLE
Provider Business Practice Location Address City Name:
BURNSVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-898-5700
Provider Business Practice Location Address Fax Number:
952-898-5757
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  102853 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: 102853 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6405884 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP48128 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 77G06BU . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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