Healthcare Provider Details

I. General information

NPI: 1992033922
Provider Name (Legal Business Name): NYAN PYAE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1997 SLOAN PL STE 17
MAPLEWOOD MN
55117-2051
US

IV. Provider business mailing address

2854 HIGHWAY 55 STE 130
EAGAN MN
55121-1447
US

V. Phone/Fax

Practice location:
  • Phone: 517-726-2516
  • Fax: 651-224-9661
Mailing address:
  • Phone: 651-224-4930
  • Fax: 651-842-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11661
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPT 11661
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number5447
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number53447
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: