Provider Demographics
NPI:1154052173
Name:ADDOW, FADUMA ABDULLAHI
Entity Type:Individual
Prefix:
First Name:FADUMA
Middle Name:ABDULLAHI
Last Name:ADDOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 UNIVERSITY AVE W STE 181
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2879
Mailing Address - Country:US
Mailing Address - Phone:161-225-9771
Mailing Address - Fax:612-259-7889
Practice Address - Street 1:1821 UNIVERSITY AVE W STE 181
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2879
Practice Address - Country:US
Practice Address - Phone:161-225-9771
Practice Address - Fax:612-259-7889
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-657-594-8208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice