Provider Demographics
NPI:1467818310
Name:AHMED, OSMAN ISAAK SR
Entity Type:Individual
Prefix:MR
First Name:OSMAN
Middle Name:ISAAK
Last Name:AHMED
Suffix:SR
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 1:1801 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1835
Mailing Address - Country:US
Mailing Address - Phone:612-226-8825
Mailing Address - Fax:612-315-3146
Practice Address - Street 1:1801 E LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1835
Practice Address - Country:US
Practice Address - Phone:612-226-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172A00000X172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver