Healthcare Provider Details

I. General information

NPI: 1285997528
Provider Name (Legal Business Name): MR. GEBREMARIAM ALEM GEBREMICAEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 PARK AVE
MINNEAPOLIS MN
55404-3378
US

IV. Provider business mailing address

GENERAL DELIVERY
SAINT PAUL MN
55101-9999
US

V. Phone/Fax

Practice location:
  • Phone: 612-872-2000
  • Fax: 612-871-1375
Mailing address:
  • Phone: 651-500-1354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: