Provider Demographics
NPI:1770939795
Name:JIBRIL, RAMZI
Entity type:Individual
Prefix:
First Name:RAMZI
Middle Name:
Last Name:JIBRIL
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 1:4300 GRIMES AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-1569
Mailing Address - Country:US
Mailing Address - Phone:651-332-4473
Mailing Address - Fax:651-305-1050
Practice Address - Street 1:4300 GRIMES AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-1569
Practice Address - Country:US
Practice Address - Phone:651-332-4473
Practice Address - Fax:651-305-1050
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle