Provider Demographics
NPI:1720025455
Name:FAIZER, RUMI (MD)
Entity Type:Individual
Prefix:
First Name:RUMI
Middle Name:
Last Name:FAIZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMMED
Other - Middle Name:RUMI
Other - Last Name:FAIZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:420 DELAWARE ST S.E.
Mailing Address - Street 2:DEPT. OF SURGERY, MMC 195, PWB
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-1485
Mailing Address - Fax:612-626-4150
Practice Address - Street 1:15030 7TH ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3811
Practice Address - Country:US
Practice Address - Phone:833-438-8763
Practice Address - Fax:833-438-8700
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050207012086S0129X
MN558962086S0129X
CAC1857862086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA235RSUQKMedicaid
MO718111OtherHEALTHLINK
MO207436304Medicaid
MOI41499Medicare UPIN
MOP00275427Medicare PIN
MO935365236Medicare PIN
MO718111OtherHEALTHLINK
MO207436304Medicaid