Provider Demographics
NPI:1609818061
Name:KREYKES, NATHANIEL S (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:S
Last Name:KREYKES
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 1:2530 CHICAGO AVE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4289
Mailing Address - Country:US
Mailing Address - Phone:612-813-8000
Mailing Address - Fax:612-813-8005
Practice Address - Street 1:2530 CHICAGO AVE
Practice Address - Street 2:SUITE 550
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4289
Practice Address - Country:US
Practice Address - Phone:612-813-8000
Practice Address - Fax:612-813-8005
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45565208000000X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH08374Medicare UPIN