Individual
TESFATSIYON MAMMO ERGANDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 DELAWARE STREET SE, MMC 284, MINNEAPOLIS, MN 55455
(612) 626-5454
Mailing address
420 DELAWARE STREET SE, MMC 284, MINNEAPOLIS, MN 55455
(612) 626-5454
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
72769
MN
208D00000X
General Practice Physician
72769
MN
Other
Enumeration date
05/13/2021
Last updated
06/18/2024
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