Healthcare Provider Details

I. General information

NPI: 1770939795
Provider Name (Legal Business Name): RAMZI JIBRIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 GRIMES AVE N
ROBBINSDALE MN
55422-1569
US

IV. Provider business mailing address

4300 GRIMES AVE N
ROBBINSDALE MN
55422-1569
US

V. Phone/Fax

Practice location:
  • Phone: 651-332-4473
  • Fax: 651-305-1050
Mailing address:
  • Phone: 651-332-4473
  • Fax: 651-305-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: