Provider Demographics
NPI:1033314943
Name:KAYAN, TRACY SO (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:SO
Last Name:KAYAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:15450 HIGHWAY 7 STE 225
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3522
Mailing Address - Country:US
Mailing Address - Phone:612-756-8008
Mailing Address - Fax:651-925-0597
Practice Address - Street 1:15450 HIGHWAY 7 STE 225
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3522
Practice Address - Country:US
Practice Address - Phone:612-756-8008
Practice Address - Fax:651-925-0597
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2022-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN54870208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery