Individual provider Active NPI

Sean Ercan-Fang, MD

  • Internal Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1093811325
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
37621 Issued in MN
Practice address
1 Veterans Dr
Minneapolis, MN 55417-2309
Phone
(612) 725-2000
NPI assigned
Sep 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 37621 MN Primary

Addresses

Primary practice location

1 Veterans Dr
Minneapolis, MN 55417-2309

Mailing address

3716 Edmund Blvd
Minneapolis, MN 55406-2945
Phone (612) 724-8128

Other names 1

  • Dr. Sean Fang Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170607002497 MN Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 2567651029

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
37621MNMDInternal Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093811325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3716 EDMUND BLVD",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554062945",
            "telephone_number": "612-724-8128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 VETERANS DR",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554172309",
            "telephone_number": "612-725-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERCAN-FANG",
        "first_name": "SEAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "37621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SEAN",
            "last_name": "FANG",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.