| Organization Name: | VEIN CLINIC PA |
| NPI Number: | 1275807521 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SAMEER GUPTA (PRESIDENT) |
| Mailing Address: | 2719 W Division St Suite 5 Saint Cloud |
| State: | MN US |
| Postal Code: | 563013822 |
| Phone Number: | 9529343296 |
| Fax Number: | 8664249049 |
| NPI Enumeration Date: | 03/05/2012 |
| NPI Last Update Date: | 12/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 1759 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |