Provider Demographics
NPI:1083476378
Name:ABDI, ABDULKADIR MOHAMED
Entity Type:Individual
Prefix:
First Name:ABDULKADIR
Middle Name:MOHAMED
Last Name:ABDI
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 1:7074 182ND ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5195
Mailing Address - Country:US
Mailing Address - Phone:612-203-0366
Mailing Address - Fax:
Practice Address - Street 1:7074 182ND ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5195
Practice Address - Country:US
Practice Address - Phone:612-203-0366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician