Individual
DR. SHAHED TISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-1003
(507) 284-2511
Mailing address
PO BOX 860912, MINNEAPOLIS, MN 55486-0912
(072) 842-5115
(000) 000-0000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2020013288
MO
208600000X
Surgery Physician
Primary
79527
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020013288
MO LICENSE
MO
Enumeration date
06/25/2019
Last updated
08/15/2025
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