Healthcare Provider Details

I. General information

NPI: 1285900118
Provider Name (Legal Business Name): MOSTAFA EL DAFRAWY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 E 26TH ST STE 600
MINNEAPOLIS MN
55404-4515
US

IV. Provider business mailing address

913 E 26TH ST STE 600
MINNEAPOLIS MN
55404-4515
US

V. Phone/Fax

Practice location:
  • Phone: 612-775-6200
  • Fax: 612-775-6222
Mailing address:
  • Phone: 612-776-6200
  • Fax: 612-775-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number78296
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036150913
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: