Individual
DR. MARYAM LEE MOGHADDAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
14500 99TH AVE N, MAPLE GROVE, MN 55369-4730
(763) 898-1000
Mailing address
16973 WEAVER LAKE DR, MAPLE GROVE, MN 55311-1435
(612) 670-5214
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
31579
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
309397200
—
MN
Enumeration date
03/31/2006
Last updated
02/07/2013
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