Healthcare Provider Details

I. General information

NPI: 1104761709
Provider Name (Legal Business Name): BIRUK GIRMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 E 46TH ST APT 404
MINNEAPOLIS MN
55406-4089
US

IV. Provider business mailing address

3550 E 46TH ST APT 404
MINNEAPOLIS MN
55406-4089
US

V. Phone/Fax

Practice location:
  • Phone: 612-286-9159
  • Fax:
Mailing address:
  • Phone: 612-286-9159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number421798
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: