Provider Demographics
NPI:1720445489
Name:GELLE, JAMAL (BS AND HALF MBA)
Entity Type:Individual
Prefix:
First Name:JAMAL
Middle Name:
Last Name:GELLE
Suffix:
Gender:M
Credentials:BS AND HALF MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 HIAWATHA AVE
Mailing Address - Street 2:APT 336
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3495
Mailing Address - Country:US
Mailing Address - Phone:408-896-7651
Mailing Address - Fax:612-293-0093
Practice Address - Street 1:3845 HIAWATHA AVE
Practice Address - Street 2:APT 336
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-3495
Practice Address - Country:US
Practice Address - Phone:408-896-7651
Practice Address - Fax:612-293-0093
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)