Active NPI
Davide Kekeocha
- Physician Assistant
- Minneapolis, MN
National Provider Identifier
1902059595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA05543
- Practice address
- 920 2ND Ave S Ste 400
Minneapolis, MN 55402-4010 - Phone
- (612) 225-1538
- NPI assigned
- Oct 28, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA05543 | TX | Primary |
Addresses
Primary practice location
920 2ND Ave S Ste 400
Minneapolis, MN 55402-4010
Mailing address
920 2ND Ave S Ste 400
Minneapolis, MN 55402-4010
Phone (612) 225-1538
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA05543 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235520000000",
"number": "1902059595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "920 2ND AVE S STE 400",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554024010",
"telephone_number": "612-225-1538"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "920 2ND AVE S STE 400",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554024010",
"telephone_number": "612-225-1538"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEKEOCHA",
"first_name": "DAVIDE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-28",
"last_updated": "2009-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA05543",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.