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NPI Code Detail

MEDICARE: DR. NYAN PYAE M.D.

MEDICARE: DR. NYAN PYAE 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
1207R00000XInternal Medicine Physician11661ND
2207R00000XInternal Medicine PhysicianPT 11661ND
3207RN0300XNephrology Physician5447MN
4390200000XStudent in an Organized Health Care Education/Training Program
5207RN0300XNephrology Physician53447MN

General Provider Information

NPI Number : 1992033922
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NYAN PYAE M.D.
Provider Business Mailing Address
First Line : 2854 HIGHWAY 55 STE 130
Second Line :
City : EAGAN
State : MN
Zip : 55121-1447
Country : US
Telephone Number : 651-224-4930
Fax Number : 651-842-3391
Provider Business Practice Location Address
First Line : 1997 SLOAN PL STE 17
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55117-2051
Country : US
Telephone Number : 517-726-2516
Fax Number : 651-224-9661
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2009
Last Update Date : 04/04/2022

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