Provider Demographics
NPI:1245204296
Name:NAIR, KAVITA (MD)
Entity Type:Individual
Prefix:
First Name:KAVITA
Middle Name:
Last Name:NAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 FORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1931
Mailing Address - Country:US
Mailing Address - Phone:612-256-8225
Mailing Address - Fax:612-457-0216
Practice Address - Street 1:2004 FORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1931
Practice Address - Country:US
Practice Address - Phone:612-256-8225
Practice Address - Fax:612-457-0216
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55699207R00000X
MN46057208M00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410081600Medicaid
MN410081600Medicaid
MNH400110420Medicare PIN
H94548Medicare UPIN