Basic Information
| Provider Information | |||||||||
| NPI: | 1255452926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEBRIAEI | ||||||||
| FirstName: | MEYSAM | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 E NICOLLET BLVD | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553375714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528922000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 347 SMITH AVE N STE 301 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551023355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512205230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 5530 | NE | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.