Healthcare Provider Details

I. General information

NPI: 1316981517
Provider Name (Legal Business Name): AFSHAN ANJUM M.B. B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE S 2A WEST
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

2450 RIVERSIDE AVE S 2A WEST
MINNEAPOLIS MN
55454-1450
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-8700
  • Fax: 612-273-8787
Mailing address:
  • Phone: 612-273-8700
  • Fax: 612-273-8787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number46330
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number46330
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: