Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 32744 | MN |
NPI | 1104839521 |
---|---|
Provider Name | Kayvon Scott Riggi |
First Address | Golden Valley, MN 55422 |
Second Address | Edina, MN 55435-1706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 22/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112975G795 | UCARE (01) | |
32130000 | WISC MEDICAID (01) | |
413318800 | (05) | MN |
550S7RI | BLUE CROSS BLUE SHIELD (01) | |
901833 | MEDICA (01) | |
969991006146 | PREFERREDONE (01) | |
F45325 | (02) | |
HP14249 | HEALTHPARTNERS (01) |