Provider Demographics
NPI:1588864151
Name:BHATTARAI, NIMESH (MD)
Entity type:Individual
Prefix:
First Name:NIMESH
Middle Name:
Last Name:BHATTARAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 STINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2614
Mailing Address - Country:US
Mailing Address - Phone:612-672-2258
Mailing Address - Fax:612-672-6041
Practice Address - Street 1:400 STINSON BLVD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2614
Practice Address - Country:US
Practice Address - Phone:612-672-2294
Practice Address - Fax:612-672-6041
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46353207R00000X
CO49638207R00000X
MN59077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38108054Medicaid
MNH400216423Medicare PIN
COCOAAA0857Medicare PIN