=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790574457
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALARI SKIN PATHOLOGY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2025
-----------------------------------------------------
Last Update Date | 05/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3445 WASHINGTON DR STE 207
-----------------------------------------------------
City | EAGAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55122-4303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-372-5274
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3445 WASHINGTON DR STE 207
-----------------------------------------------------
City | EAGAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55122-4303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-372-5274
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. BEHZAD SALARI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 833-372-5274
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZD0900X
-----------------------------------------------------
Taxonomy Name | Dermatopathology (Pathology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------