Basic Information
| Provider Information | |||||||||
| NPI: | 1669868048 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOPAL | ||||||||
| FirstName: | SUMI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2854 HIGHWAY 55 STE 190 | ||||||||
| Address2: | |||||||||
| City: | EAGAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551211783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516444277 | ||||||||
| FaxNumber: | 6516444018 | ||||||||
| Practice Location | |||||||||
| Address1: | 2854 HIGHWAY 55 STE 190 | ||||||||
| Address2: | |||||||||
| City: | EAGAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551211783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516444277 | ||||||||
| FaxNumber: | 6516444018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2015 | ||||||||
| LastUpdateDate: | 08/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RR0500X | 69312 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RR0500X | 35.140060 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.