Provider Demographics
NPI:1114173259
Name:SHUKLA, KRUTI TRIPATHI (MD)
Entity type:Individual
Prefix:MS
First Name:KRUTI
Middle Name:TRIPATHI
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KRUTI
Other - Middle Name:HARSHAVARDHAN
Other - Last Name:TRIPATHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7213 FLEETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-1811
Mailing Address - Country:US
Mailing Address - Phone:914-299-1474
Mailing Address - Fax:
Practice Address - Street 1:4300 MARKET PTE DR STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55435-5435
Practice Address - Country:US
Practice Address - Phone:952-767-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54259207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN07P00000XOtherMD NUMBER