MEDICARE: DR. ZOHREH MAHDAVI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	38852	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356333116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZOHREH MAHDAVI M.D.

Provider Business Mailing Address
First Line	:	1650 BEAM AVE
Second Line	:	SUITE 200
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1192
Country	:	US
Telephone Number	:	651-221-9051
Fax Number	:	651-223-5220

Provider Business Practice Location Address
First Line	:	1650 BEAM AVE
Second Line	:	SUITE 200
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1192
Country	:	US
Telephone Number	:	651-221-9051
Fax Number	:	651-223-5220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	01/05/2011

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