MEDICARE: JAVAD KEYHANI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	46770	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457369902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVAD KEYHANI M.D.

Provider Business Mailing Address
First Line	:	824 N 11TH ST
Second Line	:
City	:	MONTEVIDEO
State	:	MN
Zip	:	56265-1629
Country	:	US
Telephone Number	:	320-269-8877
Fax Number	:	320-269-8186

Provider Business Practice Location Address
First Line	:	2020 E 28TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1394
Country	:	US
Telephone Number	:	612-333-0776
Fax Number	:	320-269-8186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/21/2022

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