MEDICARE: DR. AYESHA EBRAHIM 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	44536	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33-00259	OTHER	MN	MEDICA
2	2418104	OTHER	MN	AMERICA'S PPO
3	33-00259	OTHER	MN	SELECT CARE
4	HP51736	OTHER	MN	HEALTHPARTNERS
5	NA9521031165	OTHER	MN	PREFERRED ONE
6	615K3EB	OTHER	MN	BLUE CROSS BLUE SHIELD
7	113138	OTHER	MN	UCARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831144609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AYESHA EBRAHIM MD

Provider Business Mailing Address
First Line	:	1185 TOWN CENTRE DR
Second Line	:	SUITE 220
City	:	EAGAN
State	:	MN
Zip	:	55123-1187
Country	:	US
Telephone Number	:	651-379-1600
Fax Number	:	651-379-1650

Provider Business Practice Location Address
First Line	:	1185 TOWN CENTRE DR
Second Line	:	SUITE 220
City	:	EAGAN
State	:	MN
Zip	:	55123-1187
Country	:	US
Telephone Number	:	651-379-1600
Fax Number	:	651-379-1650

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	02/21/2012

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