Healthcare Provider Details

I. General information

NPI: 1124071865
Provider Name (Legal Business Name): KAMIL N. SAYEGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 FRANCE AVE S STE 200
EDINA MN
55435-2164
US

IV. Provider business mailing address

1700 UNIVERSITY AVE W REV MGMT PROVIDER ENROLLMENT
SAINT PAUL MN
55104-3727
US

V. Phone/Fax

Practice location:
  • Phone: 952-848-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-128967
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number48270-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-128967
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number48270-20
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number48270
License Number StateWI
# 6
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number64921
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: