Miecal Kidane

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

4001 Stinson Blvd Ste 314
Minneapolis, MN 55421-3424

Phone

(612) 298-7636

Fax

(612) 354-3801

NPI assigned

Mar 31, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1184364796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6232 COURTLY PL",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251901",
            "telephone_number": "651-442-7552",
            "fax_number": "651-354-3801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 STINSON BLVD STE 314",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554213424",
            "telephone_number": "612-298-7636",
            "fax_number": "612-354-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDANE",
        "first_name": "MIECAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-31",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roy Kagumba Kiberenge, M.D.
• Tasha Kiberenge, PA
• George Mulinde Kibuuka
• Yolanda Kibwana
• Luke Kicklighter, MD
• Kidcare Venue
• Sara A Kidd-Lewis, RD
• Ashley Mae Kidd-Tatge
• Ashley Kidd, MS, RD, LD
• Katrina M Kidd, M.S.

• Behavior Technician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Behavior Technician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.