Provider Demographics
NPI:1073854782
Name:ADAM, ABDULFATAH SAID
Entity Type:Individual
Prefix:
First Name:ABDULFATAH
Middle Name:SAID
Last Name:ADAM
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 1:1500 CHICAGO AVE APT 32
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1609
Mailing Address - Country:US
Mailing Address - Phone:612-483-0226
Mailing Address - Fax:612-353-1113
Practice Address - Street 1:1500 CHICAGO AVE APT 32
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:612-483-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4000344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi