Provider Demographics
NPI:1598111585
Name:WARSAME, DAHIR
Entity Type:Individual
Prefix:
First Name:DAHIR
Middle Name:
Last Name:WARSAME
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 1:3055 OLD HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2500
Mailing Address - Country:US
Mailing Address - Phone:612-272-0759
Mailing Address - Fax:
Practice Address - Street 1:3055 OLD HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:SAINT ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-2500
Practice Address - Country:US
Practice Address - Phone:612-272-0759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNN824177304214343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)