Basic Information
| Provider Information | |||||||||
| NPI: | 1699955724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLDEGIORGIS | ||||||||
| FirstName: | SOLOMON | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10000 ZANE AVE N | ||||||||
| Address2: | FAIRVIEW BROOKLYN PARK CLINIC | ||||||||
| City: | BROOKLYN PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554431400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635725700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10000 ZANE AVE N | ||||||||
| Address2: | FAIRVIEW BROOKLYN PARK CLINIC | ||||||||
| City: | BROOKLYN PARK, | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554431400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635725700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2007 | ||||||||
| LastUpdateDate: | 01/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 52126 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.