Provider Demographics
NPI:1285754788
Name:DZAMESHIE, PROSPER
Entity type:Individual
Prefix:MR
First Name:PROSPER
Middle Name:
Last Name:DZAMESHIE
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 1:13566 ATHENA WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-6300
Mailing Address - Country:US
Mailing Address - Phone:612-743-8355
Mailing Address - Fax:612-870-0546
Practice Address - Street 1:13566 ATHENA WAY
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-6300
Practice Address - Country:US
Practice Address - Phone:612-743-8355
Practice Address - Fax:612-870-0546
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor