Provider Demographics
NPI:1619904208
Name:DESSIE, HELLINA TEGAGNE (DO)
Entity Type:Individual
Prefix:DR
First Name:HELLINA
Middle Name:TEGAGNE
Last Name:DESSIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1151 SILVER LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6324
Mailing Address - Country:US
Mailing Address - Phone:612-706-4500
Mailing Address - Fax:612-781-6830
Practice Address - Street 1:5502 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3508
Practice Address - Country:US
Practice Address - Phone:763-287-6500
Practice Address - Fax:763-287-6544
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN47888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN66-08890OtherMEDICA CHOICE & PRIMARY
IA0716548Medicaid
MN1032683OtherPREFERRED ONE
WI43526400Medicaid
MN686112100Medicaid
MNHP58502OtherHEALTHPARTNERS
MN106789OtherUCARE
MN66-08890OtherMEDICA CHOICE & PRIMARY
WI43526400Medicaid