MEDICARE: DR. FERESHTEH KAVEH 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	36581	MN

General Provider Information

NPI Number	:	1831173749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERESHTEH KAVEH M.D.

Provider Business Mailing Address
First Line	:	6465 WAYZATA BLVD
Second Line	:	STE 315
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-1728
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14000 FAIRVIEW DR
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-5713
Country	:	US
Telephone Number	:	952-993-8700
Fax Number	:

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/08/2007

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