Provider Demographics
NPI:1093784985
Name:NASHAWATY, MOHAMMED K (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:K
Last Name:NASHAWATY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 FRANCE AVE S
Mailing Address - Street 2:STE 210
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2281
Mailing Address - Country:US
Mailing Address - Phone:952-928-2900
Mailing Address - Fax:952-928-2944
Practice Address - Street 1:6545 FRANCE AVE S
Practice Address - Street 2:STE 210
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2281
Practice Address - Country:US
Practice Address - Phone:952-928-2900
Practice Address - Fax:952-928-2944
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43219207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1025108OtherPREFERRED ONE
MN939618700Medicaid
IL200447160Medicaid
MN45B42NAOtherBLUE CROSS BLUE SHIELD MN
MN150436OtherUCARE MN
MN1079977OtherAMERICA'S PPO
MN3600112OtherMEDICA
MNHP30982OtherHEALTHPARTNERS
WI34063600Medicaid
MN1025108OtherPREFERRED ONE
MNHP30982OtherHEALTHPARTNERS
MN939618700Medicaid