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NPI Code Detail

MEDICARE: ELIAS MULUGETA TADDESSE

MEDICARE: ELIAS MULUGETA TADDESSE
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1053261305
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIAS MULUGETA TADDESSE
Provider Business Mailing Address
First Line : 8680 OLD CEDAR AVE S APT 308
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55425-2037
Country : US
Telephone Number : 763-587-1184
Fax Number :
Provider Business Practice Location Address
First Line : 1627 WHITE BEAR AVE N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55106-1609
Country : US
Telephone Number : 651-756-1561
Fax Number : 651-528-7968
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2026
Last Update Date : 01/28/2026

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Directions to “ ELIAS MULUGETA TADDESSE ” Practice Location

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