Provider Demographics
NPI:1255452926
Name:KEBRIAEI, MEYSAM A (MD)
Entity type:Individual
Prefix:DR
First Name:MEYSAM
Middle Name:A
Last Name:KEBRIAEI
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 1:201 E NICOLLET BLVD
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5714
Mailing Address - Country:US
Mailing Address - Phone:952-892-2000
Mailing Address - Fax:
Practice Address - Street 1:347 SMITH AVE N STE 301
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3355
Practice Address - Country:US
Practice Address - Phone:651-220-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5530207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery