Individual
NISSIM KHABIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2211 PARK AVE, MINNEAPOLIS, MN 55404-3711
(612) 871-1144
(612) 871-2012
Mailing address
2211 PARK AVE, MINNEAPOLIS, MN 55404-3711
(612) 871-1144
(612) 871-2012
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
42203
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01031020
PREFERREDONE
MN
01
—
055M7KH
BLUE SHIELD
MN
01
—
1000010
MEDICA PRIMARY
MN
01
—
1000350
MEDICA CHOICE
MN
01
—
141063
UCARE
MN
01
—
1592346
AMERICA'S PPO
MN
01
—
34190100
MEDICAID - WISCONSIN
WI
05
—
951427900
—
MN
Enumeration date
08/10/2005
Last updated
03/22/2021
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