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NPI Code Detail

MEDICARE: MR. GEBREMARIAM ALEM GEBREMICAEL

MEDICARE: MR. GEBREMARIAM ALEM GEBREMICAEL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker

General Provider Information

NPI Number : 1285997528
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GEBREMARIAM ALEM GEBREMICAEL
Provider Business Mailing Address
First Line : GENERAL DELIVERY
Second Line :
City : SAINT PAUL
State : MN
Zip : 55101-9999
Country : US
Telephone Number : 651-500-1354
Fax Number :
Provider Business Practice Location Address
First Line : 2120 PARK AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-3378
Country : US
Telephone Number : 612-872-2000
Fax Number : 612-871-1375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2012
Last Update Date : 04/09/2018

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