Provider Demographics
NPI:1831144609
Name:EBRAHIM, AYESHA (MD)
Entity Type:Individual
Prefix:DR
First Name:AYESHA
Middle Name:
Last Name:EBRAHIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 TOWN CENTRE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1187
Mailing Address - Country:US
Mailing Address - Phone:651-379-1600
Mailing Address - Fax:651-379-1650
Practice Address - Street 1:1185 TOWN CENTRE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1187
Practice Address - Country:US
Practice Address - Phone:651-379-1600
Practice Address - Fax:651-379-1650
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44536207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN33-00259OtherMEDICA
MN2418104OtherAMERICA'S PPO
MN33-00259OtherSELECT CARE
MNHP51736OtherHEALTHPARTNERS
MNNA9521031165OtherPREFERRED ONE
MN615K3EBOtherBLUE CROSS BLUE SHIELD
MN113138OtherUCARE
MN80483500Medicaid
MN80483500Medicaid