MEDICARE: SIRRI A. NOMO-ONGOLO MD

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
1	207P00000X	Emergency Medicine Physician	42232	MN

General Provider Information

NPI Number	:	1306895271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIRRI A. NOMO-ONGOLO MD

Provider Business Mailing Address
First Line	:	3616 ROOSEVELT ST NE
Second Line	:
City	:	SAINT ANTHONY
State	:	MN
Zip	:	55418-1559
Country	:	US
Telephone Number	:	612-788-0448
Fax Number	:

Provider Business Practice Location Address
First Line	:	3616 ROOSEVELT ST NE
Second Line	:
City	:	SAINT ANTHONY
State	:	MN
Zip	:	55418-1559
Country	:	US
Telephone Number	:	612-706-2980
Fax Number	:	612-706-2981

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	07/08/2007

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