Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 61657 | MN |
NPI | 1013064807 |
---|---|
Provider Name | Farah Cassis-Ghavami |
First Address | Minneapolis, MN 55404-4518 |
Second Address | Minneapolis, MN 55404-4518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 12/05/2017 |