Provider Demographics
NPI:1346044864
Name:FEKRAZAD, ELAHEH
Entity type:Individual
Prefix:
First Name:ELAHEH
Middle Name:
Last Name:FEKRAZAD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2949 4TH ST SE UNIT 333
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3899
Mailing Address - Country:US
Mailing Address - Phone:517-315-9249
Mailing Address - Fax:
Practice Address - Street 1:320 W MYRTLE ST STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4457
Practice Address - Country:US
Practice Address - Phone:218-491-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program