Provider Demographics
NPI:1790337335
Name:BEKELCHO, MIDHAGA G
Entity Type:Individual
Prefix:
First Name:MIDHAGA
Middle Name:G
Last Name:BEKELCHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12357 5TH ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-2644
Mailing Address - Country:US
Mailing Address - Phone:763-316-8467
Mailing Address - Fax:
Practice Address - Street 1:12357 5TH ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-2644
Practice Address - Country:US
Practice Address - Phone:763-316-8467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-14
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN234239-7163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse