Basic Information
| Provider Information | |||||||||
| NPI: | 1780786665 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESHPANDE | ||||||||
| FirstName: | SANJAY | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052193 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 915 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142987280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2006 | ||||||||
| LastUpdateDate: | 10/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | 31209-020 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0001X | 69737 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 31768100 | 01 | WI | NETWORK HEALTH T19 | OTHER | 31768100 | 01 | MANAGED HEALTH SERVICES | OTHER | 31768100 | 01 | WI | INDEPENDENT CARE | OTHER | 31768100 | 05 | WI | MEDICAID | P00061095 | 01 | MEDICARE RR PIN | OTHER | 31768100 | 01 | ABRI HEALTHCARE T19 | OTHER | 4455639 | 01 | AETNA | OTHER | 2263828 | 01 | CIGNA | OTHER | 31768100 | 01 | AMERICHOICE T19 | OTHER |