Provider Demographics
NPI:1053580092
Name:BOUMITRI, MIRNA GEORGES (MD)
Entity type:Individual
Prefix:DR
First Name:MIRNA
Middle Name:GEORGES
Last Name:BOUMITRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:717 DELAWARE ST SE
Mailing Address - Street 2:MAIL CODE 1932
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2959
Mailing Address - Country:US
Mailing Address - Phone:612-624-6843
Mailing Address - Fax:612-626-3840
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:CLINIC 2A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-1687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.010274207R00000X
MN52751207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine