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General NPI Number Information
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NPI Number | 1245818848
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Entity Type | Individual
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Provider Name | ENEYEW TILAHUN MD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2021
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 17489 DODD BLVD
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City | LAKEVILLE
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State | MN
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Zip | 55044-6506
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Country | US
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Telephone | 952-428-1020
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Fax | 952-428-1025
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Provider Business Mailing Address
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Address Line | 2925 CHICAGO AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-1321
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Country | US
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Telephone | 612-262-5000
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 79207
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License Number State | MN
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