Provider Demographics
NPI:1851393839
Name:KHABIE, NISSIM (MD)
Entity Type:Individual
Prefix:
First Name:NISSIM
Middle Name:
Last Name:KHABIE
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 1:2211 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3711
Mailing Address - Country:US
Mailing Address - Phone:612-871-1144
Mailing Address - Fax:612-871-2012
Practice Address - Street 1:2211 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3711
Practice Address - Country:US
Practice Address - Phone:612-871-1144
Practice Address - Fax:612-871-2012
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42203207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34190100OtherMEDICAID - WISCONSIN
MN1000350OtherMEDICA CHOICE
MN1000010OtherMEDICA PRIMARY
MN1592346OtherAMERICA'S PPO
MN01031020OtherPREFERREDONE
MN141063OtherUCARE
MN951427900Medicaid
MN055M7KHOtherBLUE SHIELD
MNH08604Medicare UPIN
MN040000639Medicare PIN