Provider Demographics
NPI:1902872047
Name:TEEPARTI, REWATI (MD)
Entity Type:Individual
Prefix:
First Name:REWATI
Middle Name:
Last Name:TEEPARTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MC21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-254-9594
Mailing Address - Fax:763-287-5019
Practice Address - Street 1:8170 33RD AVE S
Practice Address - Street 2:MC21110Q
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-4516
Practice Address - Country:US
Practice Address - Phone:651-254-9594
Practice Address - Fax:763-287-5019
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43355207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN804512300Medicaid
MN804512300Medicaid
H31118Medicare UPIN