Provider Demographics
NPI:1386139327
Name:DWIVEDI, NISHANT (MD)
Entity type:Individual
Prefix:DR
First Name:NISHANT
Middle Name:
Last Name:DWIVEDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NISHANT
Other - Middle Name:NEELKANTH
Other - Last Name:DWIVEDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3500 AMERICAN BLVD W STE 300
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-4442
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:
Practice Address - Street 1:11225 ULYSSES ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4261
Practice Address - Country:US
Practice Address - Phone:763-302-2600
Practice Address - Fax:763-302-2601
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN77124207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery