Provider Demographics
NPI:1093760290
Name:LEMMA, GIRUM L (MD)
Entity Type:Individual
Prefix:
First Name:GIRUM
Middle Name:L
Last Name:LEMMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE W STE 110N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2001
Mailing Address - Country:US
Mailing Address - Phone:651-602-5311
Mailing Address - Fax:651-222-6786
Practice Address - Street 1:6025 LAKE RD STE 110
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1709
Practice Address - Country:US
Practice Address - Phone:651-735-7414
Practice Address - Fax:651-735-1827
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062226A208M00000X
MN52821207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9450969OtherPHCS PID NUMBER
IN000000485519OtherANTHEM PROVIDER NUMBER
IN200827030Medicaid
INI62068Medicare UPIN
I62068Medicare UPIN
IN815460HHHHMedicare PIN
IN200827030Medicaid