1548292352 NPI number — DR. RAHEL GHEBRE M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548292352 NPI number — DR. RAHEL GHEBRE M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GHEBRE

Provider First Name:

RAHEL

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1548292352

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/25/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

420 DELAWARE ST SE

Provider Second Line Business Mailing Address:

MMC 395 UNIVERSITY OF MINNESOTA PHYSICIANS

Provider Business Mailing Address City Name:

MINNEAPOLIS

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55455-0341

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

612-626-3111

Provider Business Mailing Address Fax Number:

612-626-0665

Provider First Line Business Practice Location Address:

516 DELAWARE ST SE

Provider Second Line Business Practice Location Address:

UNIVERSITY OF MINNESOTA PH, PWB FIRST FLOOR, CLINIC 1C

Provider Business Practice Location Address City Name:

MINNEAPOLIS

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55455-0356

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

612-626-3444

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

07/06/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207V00000X , with the licence number:  42884 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207VX0201X , with the licence number: 42884 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0087448 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 34003700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
• Identifier: 07-00036 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 07-03937 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 111436 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 1024752 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 1056428 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 0533703 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 78R26GH . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 908124100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: HP31254 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".