MEDICARE: KAMAL KADIR KABETO

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	374U00000X	Home Health Aide
2	253Z00000X	In Home Supportive Care Agency	1103105	MN

General Provider Information

NPI Number	:	1750983441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMAL KADIR KABETO

Provider Business Mailing Address
First Line	:	1508 MARYLAND AVE E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-2803
Country	:	US
Telephone Number	:	763-218-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 MARYLAND AVE E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-2803
Country	:	US
Telephone Number	:	763-218-8700
Fax Number	:

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

Provider Enumeration Date	:	11/09/2020
Last Update Date	:	02/13/2021

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Directions to “ KAMAL KADIR KABETO ” Practice Location

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