Provider Demographics
NPI:1740615582
Name:NISHIKAWA, GO (MD)
Entity type:Individual
Prefix:
First Name:GO
Middle Name:
Last Name:NISHIKAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 W BROADWAY AVE STE 1135
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2974
Mailing Address - Country:US
Mailing Address - Phone:763-581-2800
Mailing Address - Fax:763-581-2801
Practice Address - Street 1:3435 W BROADWAY AVE STE 1135
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2974
Practice Address - Country:US
Practice Address - Phone:763-581-2800
Practice Address - Fax:763-581-2801
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN80145207R00000X, 207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology