Provider Demographics
NPI:1366552317
Name:KHIMJI, TASNEEM N (MD)
Entity type:Individual
Prefix:
First Name:TASNEEM
Middle Name:N
Last Name:KHIMJI
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 1:11995 SINGLETREE LN STE 500
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5349
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:11995 SINGLETREE LN STE 500
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5349
Practice Address - Country:US
Practice Address - Phone:952-595-1301
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0589612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341046795026OtherCARESOURCE
OH341046795AOtherAULTCARE INS
OH731514OtherBUCKEYE COMM HEALTH PLAN
OH000000025112OtherANTHEM BC/BS
OH300076005OtherRAILROAD MEDICARE
OH341046795005OtherMEDICAL MUTUAL OF OHIO
OH58042OtherQUALCHOICE
OH341046795LOOtherSUMMACARE INS
OH0882102Medicaid
OH731514OtherBUCKEYE COMM HEALTH PLAN
OH341046795AOtherAULTCARE INS
OH300076005OtherRAILROAD MEDICARE
OH58042OtherQUALCHOICE
OH341046795LOOtherSUMMACARE INS
OH0720358Medicare PIN
OH0843834Medicare PIN
OH0783803Medicare PIN