Healthcare Provider Details

I. General information

NPI: 1720395114
Provider Name (Legal Business Name): ALIRAZA DINANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 08/31/2024
Certification Date: 08/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 W FOUNTAIN ST
ALBERT LEA MN
56007
US

IV. Provider business mailing address

404 W FOUNTAIN ST
ALBERT LEA MN
56007-2437
US

V. Phone/Fax

Practice location:
  • Phone: 507-373-2384
  • Fax:
Mailing address:
  • Phone: 507-373-2384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number276058
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: