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General NPI Number Information
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NPI Number | 1790746394
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Entity Type | Individual
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Provider Name | ALI REZA ESMAEILZADEH MD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 2945 HAZELWOOD ST STE 100
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1242
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Country | US
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Telephone | 651-232-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 2396 ARNOLD PALMER DR
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City | BLAINE
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State | MN
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Zip | 55449-5517
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Country | US
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Telephone | 651-343-3403
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 43644
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License Number State | MN
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