Provider Demographics
NPI:1881686491
Name:NISI, KURT W (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:W
Last Name:NISI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7401 METRO BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3026
Mailing Address - Country:US
Mailing Address - Phone:952-920-4915
Mailing Address - Fax:952-915-6091
Practice Address - Street 1:NORTH RADIATION THERAPY CTR
Practice Address - Street 2:3300 OAKDALE AVE N
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-521-1426
Practice Address - Fax:763-521-1432
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN366492085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110586OtherCHOICE PLUS
MN27A19NIOtherBLUE CROSS/BLUE SHIELD
MN302578OtherAMERICA'S PPO
MNHP20823OtherHEALTH PARTNERS
MN115463OtherUCARE
MN9630701012228OtherPREFERRED ONE
MN2400007OtherMEDICA
MN412014100Medicaid
MN2400004OtherMEDICA PRIMARY
WI32289600Medicaid