Provider Demographics
NPI:1477709822
Name:SEBONEGO, MPHO P (MD)
Entity Type:Individual
Prefix:DR
First Name:MPHO
Middle Name:P
Last Name:SEBONEGO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:763-587-4205
Practice Address - Street 1:1833 2ND AVE S - MAIL STOP 39300A
Practice Address - Street 2:RIVERWAY CLINIC - ANOKA
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2432
Practice Address - Country:US
Practice Address - Phone:763-587-4400
Practice Address - Fax:763-587-4205
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2011-12-01
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Provider Licenses
StateLicense IDTaxonomies
MN50968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine