Basic Information
| Provider Information | |||||||||
| NPI: | 1134174022 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAZARIAN | ||||||||
| FirstName: | GWEN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 NICOLLET AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732232 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 NICOLLET AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732232 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 05/01/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 35073 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 766039 | 01 | MN | AMERICA'S PPO | OTHER | 1010359 | 01 | MN | PREFERRED ONE | OTHER | 004D5NA | 01 | MN | BLUE CROSS | OTHER | 45D71NA | 01 | MN | BLUE CROSS | OTHER | 151105 | 05 | IA | MEDICAID | HP21404 | 01 | MN | HEALTHPARTNERS | OTHER | 532590100 | 05 | MN | MEDICAID | 105563 | 01 | MN | UCARE | OTHER | 31777600 | 05 | WI | MEDICAID | 300117464 | 01 | MN | RAILROAD MEDICARE MN | OTHER |