Provider Demographics
NPI:1699863274
Name:KASHTAN, CLIFFORD E (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:E
Last Name:KASHTAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS MMC 491
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-6777
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:PWB FOURTH FLOOR, ROOM 4-100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN287332080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0012699Medicaid
MN31-24906OtherMEDICA-CHOICE
MN052035OtherFAIRVIEW CARE GIVER ID
MN109962OtherPATIENT CHOICE
OH2105760Medicaid
MN101069OtherU CARE
MN31-74533OtherMEDICA-PRIMARY
MN370010935OtherRAIL ROAD MEDICARE
MN629885100Medicaid
MN1009162OtherPREFERRED ONE
WI30852900Medicaid
MNHP13656OtherHEALTH PARTNERS
IA0506212Medicaid
MN768184OtherAMERICA'S PPO
MN2T289KAOtherBLUE CROSS BLUE SHIELD
MT0012699Medicaid
MN31-74533OtherMEDICA-PRIMARY