Provider Demographics
NPI:1982620332
Name:NIKAKHTAR, NERSI (MD)
Entity Type:Individual
Prefix:DR
First Name:NERSI
Middle Name:
Last Name:NIKAKHTAR
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 1:7201 WALKER ST APT 416
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4185
Mailing Address - Country:US
Mailing Address - Phone:612-802-9978
Mailing Address - Fax:612-467-1913
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:1110
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-1964
Practice Address - Fax:612-467-1913
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44917-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine