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General NPI Number Information
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NPI Number | 1063656593
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Entity Type | Individual
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Provider Name | NATHAN TSEBOH CHOMILO M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 08/06/2016
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Provider Practice Location Address
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Address Line | 6000 EARLE BROWN DR PEDIATRICS
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City | BROOKLYN CENTER
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State | MN
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Zip | 55430-2506
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Country | US
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Telephone | 952-993-4909
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Fax |
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Provider Business Mailing Address
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Address Line | 6000 EARLE BROWN DR PEDIATRICS
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City | BROOKLYN CENTER
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State | MN
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Zip | 55430-2506
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Country | US
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Telephone | 952-993-4909
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 53869
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 53689
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License Number State | MN
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