Provider Demographics
NPI:1538335302
Name:TOTOE, GRACE ABENA BIRAGO (M D)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:ABENA BIRAGO
Last Name:TOTOE
Suffix:
Gender:F
Credentials:M D
Other - Prefix:DR
Other - First Name:GRACE
Other - Middle Name:ABENA BIRAGO
Other - Last Name:TOTOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M D
Mailing Address - Street 1:15635 59TH PL N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3677
Mailing Address - Country:US
Mailing Address - Phone:215-876-5703
Mailing Address - Fax:888-507-5033
Practice Address - Street 1:3300 OAKDALE AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2926
Practice Address - Country:US
Practice Address - Phone:763-520-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-42653207R00000X
MN53842208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB3492001OtherMEDICARE PTAN
MNH400253193OtherMEDICARE PTAN
MNH400253193OtherMEDICARE PTAN