1104839521 NPI number — KAYVON SCOTT RIGGI M.D.

Table of content: KAYVON SCOTT RIGGI M.D. (NPI 1104839521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104839521 NPI number — KAYVON SCOTT RIGGI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIGGI
Provider First Name:
KAYVON
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104839521
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4200 DAHLBERG DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
GOLDEN VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-512-5600
Provider Business Mailing Address Fax Number:
952-512-5651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4010 W 65TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-1706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-456-7000
Provider Business Practice Location Address Fax Number:
952-456-7001
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  32744 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 901833 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112975G795 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32130000 . This is a "WISC MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP14249 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 550S7RI . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 969991006146 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 413318800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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