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NPI Code Detail

MEDICARE: MR. LEUL GEBRE HABTE

MEDICARE: MR. LEUL GEBRE HABTE
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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A723975000OTHERMNMN DHS

General Provider Information

NPI Number : 1558184853
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LEUL GEBRE HABTE
Provider Business Mailing Address
First Line : 7132 PORTLAND AVE
Second Line :
City : RICHFIELD
State : MN
Zip : 55423-3264
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7132 PORTLAND AVE
Second Line :
City : RICHFIELD
State : MN
Zip : 55423-3264
Country : US
Telephone Number : 651-217-3637
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2024
Last Update Date : 11/05/2024

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Directions to “ MR. LEUL GEBRE HABTE ” Practice Location

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