Provider Demographics
NPI:1073935367
Name:ABU-MUNYE, IBRAHIM MUNYE (CEO)
Entity Type:Individual
Prefix:MR
First Name:IBRAHIM
Middle Name:MUNYE
Last Name:ABU-MUNYE
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 PILLSBURY AVE S
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3258
Mailing Address - Country:US
Mailing Address - Phone:612-481-0934
Mailing Address - Fax:
Practice Address - Street 1:2435 PILLSBURY AVE S
Practice Address - Street 2:SUITE 405
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3258
Practice Address - Country:US
Practice Address - Phone:612-481-0934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath