Healthcare Provider Details

I. General information

NPI: 1407408172
Provider Name (Legal Business Name): DR. HADI AMRO JARADEH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE STREET MMC 276; PACCS MEDICINE
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

420 DELAWARE STREET MMC 276; PACCS MEDICINE
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-8383
  • Fax: 612-352-2174
Mailing address:
  • Phone:
  • Fax: 612-352-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number81640
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number81640
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: