Healthcare Provider Details

I. General information

NPI: 1407896533
Provider Name (Legal Business Name): QIWEN ZHANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 NW 26TH ST
OWATONNA MN
55060-5503
US

IV. Provider business mailing address

3455 OLD BRAINARD RD
CLEVELAND OH
44122-4205
US

V. Phone/Fax

Practice location:
  • Phone: 865-342-8900
  • Fax:
Mailing address:
  • Phone: 216-849-6678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35082626
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number64900
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: