Provider Demographics
NPI:1114347499
Name:BYRNE, RAZAAN NADIYA (MD)
Entity Type:Individual
Prefix:
First Name:RAZAAN
Middle Name:NADIYA
Last Name:BYRNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAZAAN
Other - Middle Name:NADIYA
Other - Last Name:YASSIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:MAIL STOP CSC-390
Mailing Address - Street 2:2525 CHICAGO AVENUE S
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:612-813-6107
Mailing Address - Fax:612-813-7473
Practice Address - Street 1:2530 CHICAGO AVE
Practice Address - Street 2:SUITE 390
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4289
Practice Address - Country:US
Practice Address - Phone:612-813-6107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61844208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty