Individual
MARYAM ZEHTABPOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
320 E MAIN ST, CROSBY, MN 56441-1645
(218) 546-7000
(218) 545-4456
Mailing address
320 E MAIN ST, CROSBY, MN 56441-1645
(218) 546-7000
(218) 545-4456
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
11326
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11326
MINNESOTA LICENSE
MN
Enumeration date
07/31/2013
Last updated
07/31/2013
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