Individual
BENYAM D ADDISSIE
Active
Individual
BENYAM D ADDISSIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
55198
MN
207RG0100X
Gastroenterology Physician
Primary
55198
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01165806
RAILROAD MEDICARE
MN
Enumeration date
06/16/2011
Last updated
08/30/2020
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