MEDICARE: DR. FATMA AL-MOTASSEM REDA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	24164	MN

General Provider Information

NPI Number	:	1043238934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FATMA AL-MOTASSEM REDA MD

Provider Business Mailing Address
First Line	:	PO BOX 6210
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87499-6210
Country	:	US
Telephone Number	:	505-609-2258
Fax Number	:	505-609-2259

Provider Business Practice Location Address
First Line	:	7800 BAILEY DR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55347-1175
Country	:	US
Telephone Number	:	952-484-9006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/20/2019

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