Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 985 | MN |
NPI | 1134412802 |
---|---|
Provider Name | Dr. Karimah Z Shabazz |
First Address | Minneapolis, MN 55412-1106 |
Second Address | Richfield, MN 55423-3398 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2011 |
Last Update Date | 29/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00001005944 | ANTHEM BCBS (01) | OH |
0116788 | (05) | OH |
1134412802 | (05) | MN |