Healthcare Provider Details

I. General information

NPI: 1881686491
Provider Name (Legal Business Name): KURT W NISI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTH RADIATION THERAPY CTR 3300 OAKDALE AVE N
ROBBINSDALE MN
55422
US

IV. Provider business mailing address

7401 METRO BLVD STE 150
EDINA MN
55439-3026
US

V. Phone/Fax

Practice location:
  • Phone: 763-521-1426
  • Fax: 763-521-1432
Mailing address:
  • Phone: 952-920-4915
  • Fax: 952-915-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number36649
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: