Provider Demographics
NPI:1497193536
Name:ANNUR CLINIC LLC
Entity Type:Organization
Organization Name:ANNUR CLINIC LLC
Other - Org Name:ANNUR CLINIC LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:IMAM
Authorized Official - Prefix:
Authorized Official - First Name:MAKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-521-1749
Mailing Address - Street 1:1729 LYNDALE AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-3349
Mailing Address - Country:US
Mailing Address - Phone:612-521-1746
Mailing Address - Fax:612-521-1282
Practice Address - Street 1:1729 LYNDALE AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-3349
Practice Address - Country:US
Practice Address - Phone:612-521-1746
Practice Address - Fax:612-521-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service