Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 56598 | MN |
Y | 111NI0900X | Internist | 56598 | MN |
NPI | 1003170952 |
---|---|
Provider Name | Daniel Tesfaye Kebed |
First Address | Rochester, MN 55905-0001 |
Second Address | Minneapolis, MN 55454-1450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 10/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P01226095 | MEDICARE RAILROAD (01) | MN |