Healthcare Provider Details

I. General information

NPI: 1013200666
Provider Name (Legal Business Name): ASIF KARIMBHAI MAKNOJIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST
SAINT PAUL MN
55101-2502
US

IV. Provider business mailing address

8170 33RD AVE MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-495-6600
  • Fax: 952-883-9677
Mailing address:
  • Phone: 651-495-6600
  • Fax: 952-883-9677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number63389
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: