Provider Demographics
NPI:1134174022
Name:NAZARIAN, GWEN K (MD)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:K
Last Name:NAZARIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 NICOLLET AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2420
Mailing Address - Country:US
Mailing Address - Phone:612-573-2232
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:1221 NICOLLET AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2420
Practice Address - Country:US
Practice Address - Phone:612-573-2232
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN350732085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN766039OtherAMERICA'S PPO
MN1010359OtherPREFERRED ONE
MN004D5NAOtherBLUE CROSS
MN45D71NAOtherBLUE CROSS
IA151105Medicaid
MNHP21404OtherHEALTHPARTNERS
MN532590100Medicaid
MN105563OtherUCARE
WI31777600Medicaid
MN300117464OtherRAILROAD MEDICARE MN
MN766039OtherAMERICA'S PPO
MN004D5NAOtherBLUE CROSS
MNF15589Medicare UPIN
IA151105Medicaid