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NPI Code Detail

MEDICARE: HICHAM DABAJA MD

MEDICARE: HICHAM DABAJA 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
12084N0402XNeurology with Special Qualifications in Child Neurology Physician67544MN
22084E0001XEpilepsy Physician67544MN

General Provider Information

NPI Number : 1346735750
Entity Type Code : Individual
Provider Name (Legal Business Name) : HICHAM DABAJA MD
Provider Business Mailing Address
First Line : 2450 RIVERSIDE AVE
Second Line : EXPLORED CLINIC-12TH FLOOR
City : MINNEAPOLIS
State : MN
Zip : 55454-1450
Country : US
Telephone Number : 612-273-0690
Fax Number : 612-273-0886
Provider Business Practice Location Address
First Line : 2450 RIVERSIDE AVE
Second Line : EXPLORED CLINIC-12TH FLOOR
City : MINNEAPOLIS
State : MN
Zip : 55454-1450
Country : US
Telephone Number : 612-273-0690
Fax Number : 612-273-0886
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2018
Last Update Date : 01/16/2026

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