Provider Demographics
NPI:1477582765
Name:FATEMI, SEYYED HOSSEIN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:SEYYED
Middle Name:HOSSEIN
Last Name:FATEMI
Suffix:
Gender:M
Credentials:MD, PHD
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 2:2312 SOUTH 6TH STREET, SUITE F256 / 2B WEST
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454
Mailing Address - Country:US
Mailing Address - Phone:612-273-9800
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:2312 SOUTH 6TH STREET, SUITE F256 / 2B WEST
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-273-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN390342084P0800X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1012200OtherPREFERRED ONE
MN124723900Medicaid
MN15-41774OtherUBH
MNHP22337OtherHEALTHPARTNERS
MN768106OtherARAZ
IA0999508Medicaid
WI32252200Medicaid
MN34Y45FAOtherBCBS
MN15-83243OtherMEDICA
MN15-41774OtherUBH
MNHP22337OtherHEALTHPARTNERS