Basic Information
Provider Information
NPI: 1407916703
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAMADANI
FirstName: UZMA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD, PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2634 CROSBY RD
Address2:  
City: WAYZATA
State: MN
PostalCode: 553912320
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 4225 GOLDEN VALLEY RD
Address2:  
City: GOLDEN VALLEY
State: MN
PostalCode: 554224215
CountryCode: US
TelephoneNumber: 7635880661
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/11/2006
LastUpdateDate: 05/19/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/19/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207T00000X59792MNY Allopathic & Osteopathic PhysiciansNeurological Surgery 

No ID Information.


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