Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 3472740 | IL |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 60702 | MN |
NPI | 1366704553 |
---|---|
Provider Name | Yasser Chebli |
First Address | Blaine, MN 55449-5866 |
Second Address | Edina, MN 55435-2133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2012 |
Last Update Date | 16/10/2020 |