Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 63712 | MN |
NPI | 1174008288 |
---|---|
Provider Name | Maen Abou-Ghaida |
First Address | Crookston, MN 56716-1601 |
Second Address | Crookston, MN 56716-1601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2018 |
Last Update Date | 08/04/2019 |