Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 25MA09886900 | NJ |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 59252 | MN |
NPI | 1215258462 |
---|---|
Provider Name | Dr. Eiman Shafa |
First Address | Minneapolis, MN 55404-4515 |
Second Address | Minneapolis, MN 55404-4515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 10/11/2020 |