Provider Demographics
NPI:1003110545
Name:ALO, ABDIRAZAK M
Entity Type:Individual
Prefix:MR
First Name:ABDIRAZAK
Middle Name:M
Last Name:ALO
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 1:2740 MINNEHAHA AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3776
Mailing Address - Country:US
Mailing Address - Phone:612-728-3000
Mailing Address - Fax:612-728-8000
Practice Address - Street 1:2740 MINNEHAHA AVE STE 160
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-3776
Practice Address - Country:US
Practice Address - Phone:612-728-3000
Practice Address - Fax:612-728-8000
Is Sole Proprietor?:No
Enumeration Date:2010-12-24
Last Update Date:2010-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4744174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist