Provider Demographics
NPI:1063045417
Name:DIIS, ABDIRIZAK
Entity Type:Individual
Prefix:
First Name:ABDIRIZAK
Middle Name:
Last Name:DIIS
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 1:2310 JAMES AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-1933
Mailing Address - Country:US
Mailing Address - Phone:309-749-5592
Mailing Address - Fax:
Practice Address - Street 1:2310 JAMES AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-1933
Practice Address - Country:US
Practice Address - Phone:309-749-5592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide