Basic Information
| Provider Information | |||||||||
| NPI: | 1316981517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANJUM | ||||||||
| FirstName: | AFSHAN | ||||||||
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| Credential: | M.B. B.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 RIVERSIDE AVE S | ||||||||
| Address2: | 2A WEST | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122738700 | ||||||||
| FaxNumber: | 6122738787 | ||||||||
| Practice Location | |||||||||
| Address1: | 2450 RIVERSIDE AVE S | ||||||||
| Address2: | 2A WEST | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122738700 | ||||||||
| FaxNumber: | 6122738787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 2084P0800X | 46330 | MN | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | 46330 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | HP48313 | 01 | MN | HEALTHPARTNERS | OTHER | 181603900 | 05 | MN | MEDICAID | C620 | 01 | MN | CHAMPUS/TRIWEST | OTHER | 0589853 | 05 | IA | MEDICAID | 15-64903 | 01 | MN | MEDICA CHOICE | OTHER | 174R9AN | 01 | MN | BCBS | OTHER | 0081600 | 05 | MT | MEDICAID | 1042741 | 01 | MN | PREFERRED ONE | OTHER | 136210 | 01 | MN | UCARE | OTHER | 2280058 | 01 | MN | ARAZ | OTHER |