Provider Demographics
NPI:1508443144
Name:SHIFA METRO CLINIC PLLC
Entity Type:Organization
Organization Name:SHIFA METRO CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDIRIZAK
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-395-2222
Mailing Address - Street 1:5270 W. 84TH STREET
Mailing Address - Street 2:SUITE 370
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1377
Mailing Address - Country:US
Mailing Address - Phone:952-395-5222
Mailing Address - Fax:952-395-5333
Practice Address - Street 1:5270 W 84TH ST STE 370
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-1377
Practice Address - Country:US
Practice Address - Phone:952-395-5222
Practice Address - Fax:952-395-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61163OtherLICENSE