Provider Demographics
NPI:1740224948
Name:ELKADI, GHASSAN HOSNI (MD)
Entity Type:Individual
Prefix:
First Name:GHASSAN
Middle Name:HOSNI
Last Name:ELKADI
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 1:6405 FRANCE AVE S
Mailing Address - Street 2:SUITE W440
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2163
Mailing Address - Country:US
Mailing Address - Phone:952-927-7004
Mailing Address - Fax:952-927-5146
Practice Address - Street 1:6405 FRANCE AVE S
Practice Address - Street 2:SUITE W440
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2163
Practice Address - Country:US
Practice Address - Phone:952-927-7004
Practice Address - Fax:952-927-5146
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002002015174400000X
RIMD12538207R00000X, 208M00000X
LAMD.203746207RC0000X
MN53881207R00000X, 208M00000X, 207RC0000X, 2086S0129X
WI64127207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2110055Medicaid
RIGE69874Medicaid
MS04656797Medicaid
RIGE69874Medicaid
MOI01599Medicare UPIN
RI007059895Medicare PIN
MS04656797Medicaid
RI007059895Medicare PIN