Healthcare Provider Details

I. General information

NPI: 1548292352
Provider Name (Legal Business Name): RAHEL GHEBRE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 DELAWARE ST SE UNIVERSITY OF MINNESOTA PH, PWB FIRST FLOOR, CLINIC 1C
MINNEAPOLIS MN
55455-0356
US

IV. Provider business mailing address

420 DELAWARE ST SE MMC 395 UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55455-0341
US

V. Phone/Fax

Practice location:
  • Phone: 612-626-3444
  • Fax:
Mailing address:
  • Phone: 612-626-3111
  • Fax: 612-626-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number42884
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number42884
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: