MEDICARE: OMAR HASSAN ROBE ACADEMIC DEGREE

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	171M00000X	Case Manager/Care Coordinator		MN

General Provider Information

NPI Number	:	1205407194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAR HASSAN ROBE ACADEMIC DEGREE

Provider Business Mailing Address
First Line	:	1517 88TH AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55444-1358
Country	:	US
Telephone Number	:	612-735-3198
Fax Number	:

Provider Business Practice Location Address
First Line	:	1517 88TH AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55444-1358
Country	:	US
Telephone Number	:	612-735-3198
Fax Number	:

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

Provider Enumeration Date	:	07/02/2021
Last Update Date	:	07/02/2021

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