Provider Demographics
NPI:1568227007
Name:YEROW, AHMEDNOOR IBRAHIM
Entity Type:Individual
Prefix:
First Name:AHMEDNOOR
Middle Name:IBRAHIM
Last Name:YEROW
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 1:1185 N CONCORD ST S
Mailing Address - Street 2:327
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075
Mailing Address - Country:US
Mailing Address - Phone:720-771-1294
Mailing Address - Fax:
Practice Address - Street 1:1185 N CONCORD ST S
Practice Address - Street 2:327
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55075
Practice Address - Country:US
Practice Address - Phone:720-771-1294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNG000068561100172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty