Basic Information
| Provider Information | |||||||||
| NPI: | 1588864151 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHATTARAI | ||||||||
| FirstName: | NIMESH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 STINSON BLVD | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554132614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126722258 | ||||||||
| FaxNumber: | 6126726041 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 STINSON BLVD | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554132614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126722294 | ||||||||
| FaxNumber: | 6126726041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2007 | ||||||||
| LastUpdateDate: | 11/10/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 46353 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 49638 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 59077 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 38108054 | 05 | CO | MEDICAID |