Provider Demographics
NPI:1578938296
Name:ALI, ABDIRAHMAN
Entity Type:Individual
Prefix:MR
First Name:ABDIRAHMAN
Middle Name:
Last Name:ALI
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 1:11356 CEDAR POINTE DR N
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2987
Mailing Address - Country:US
Mailing Address - Phone:612-872-8659
Mailing Address - Fax:888-510-1223
Practice Address - Street 1:11356 CEDAR POINTE DR N
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2987
Practice Address - Country:US
Practice Address - Phone:612-872-8659
Practice Address - Fax:888-510-1223
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172A00000X172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver