Provider Demographics
NPI:1992737878
Name:GEORGIEFF, MICHAEL KARA (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KARA
Last Name:GEORGIEFF
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:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 39
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-0644
Mailing Address - Fax:612-624-8176
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-365-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27855208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0052169Medicaid
MN1009114OtherPREFERRED ONE
MN101183OtherUCARE
MNHP13359OtherHEALTHPARTNERS
IA0963025Medicaid
MN47-24843OtherMEDICA CHOICE
MN47-74517OtherMEDICA PRIMARY
MN2T279GEOtherBCBS
MN604714OtherARAZ
MN101183OtherUCARE
MN47-24843OtherMEDICA CHOICE
MT0052169Medicaid