Provider Demographics
NPI:1265497556
Name:KOOZEKANANI, DARA D (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DARA
Middle Name:D
Last Name:KOOZEKANANI
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Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:1314 MARQUETTE AVE
Mailing Address - Street 2:APT 1907
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-4111
Mailing Address - Country:US
Mailing Address - Phone:612-605-2437
Mailing Address - Fax:612-234-4664
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:MMC 493
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-625-9600
Practice Address - Fax:612-625-3693
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-06-10
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Provider Licenses
StateLicense IDTaxonomies
MN51736207W00000X
WI50244207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology