Healthcare Provider Details

I. General information

NPI: 1700381266
Provider Name (Legal Business Name): ZACHARY SHAHEEN MD/PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 06/14/2024
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

ACADEMIC OFFICE BUILDING 2450 RIVERSIDE AVE S AO-10 PEDIATRIC RHEUMATOLOGY, ALLERGY, & IMMUNOLOGY
MINNEAPOLIS MN
55454
US

V. Phone/Fax

Practice location:
  • Phone: 612-365-6777
  • Fax:
Mailing address:
  • Phone: 612-626-4598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number69487
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: