Provider Demographics
NPI:1104839521
Name:RIGGI, KAYVON SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:KAYVON
Middle Name:SCOTT
Last Name:RIGGI
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 1:4200 DAHLBERG DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5651
Practice Address - Street 1:4010 W 65TH ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1706
Practice Address - Country:US
Practice Address - Phone:952-456-7000
Practice Address - Fax:952-456-7001
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN32744207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
901833OtherMEDICA
112975G795OtherUCARE
32130000OtherWISC MEDICAID
HP14249OtherHEALTHPARTNERS
550S7RIOtherBLUE CROSS BLUE SHIELD
969991006146OtherPREFERREDONE
MN413318800Medicaid
F45325Medicare UPIN
MN413318800Medicaid