Healthcare Provider Details

I. General information

NPI: 1477582765
Provider Name (Legal Business Name): SEYYED HOSSEIN FATEMI M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF MINNESOTA PHYSICIANS 2312 SOUTH 6TH STREET, SUITE F256 / 2B WEST
MINNEAPOLIS MN
55454
US

IV. Provider business mailing address

UNIVERSITY OF MINNESOTA PHYSICIANS 2312 SOUTH 6TH STREET, SUITE F256 / 2B WEST
MINNEAPOLIS MN
55454
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-8700
  • Fax:
Mailing address:
  • Phone: 612-273-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39034
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number39034
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: