Healthcare Provider Details

I. General information

NPI: 1740615582
Provider Name (Legal Business Name): GO NISHIKAWA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 W BROADWAY AVE STE 1135
ROBBINSDALE MN
55422-2974
US

IV. Provider business mailing address

3435 W BROADWAY AVE STE 1135
ROBBINSDALE MN
55422-2974
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-2800
  • Fax: 763-581-2801
Mailing address:
  • Phone: 763-581-2800
  • Fax: 763-581-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number80145
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number80145
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number80145
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: