Provider Demographics
NPI:1033720024
Name:ABDULLAHI, ABDIWALI H
Entity Type:Individual
Prefix:
First Name:ABDIWALI
Middle Name:H
Last Name:ABDULLAHI
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 1:3110 OLD HIGHWAY 8 UNIT 206
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1160
Mailing Address - Country:US
Mailing Address - Phone:469-910-3379
Mailing Address - Fax:
Practice Address - Street 1:3110 OLD HIGHWAY 8 UNIT 206
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1160
Practice Address - Country:US
Practice Address - Phone:469-910-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health