Provider Demographics
NPI:1619376878
Name:HUSSEIN, ABDULLAHI (PA-C)
Entity Type:Individual
Prefix:
First Name:ABDULLAHI
Middle Name:
Last Name:HUSSEIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 BLAISDELL AVE
Mailing Address - Street 2:APT 108
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2345
Mailing Address - Country:US
Mailing Address - Phone:612-205-9326
Mailing Address - Fax:
Practice Address - Street 1:327 CEDAR AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1030
Practice Address - Country:US
Practice Address - Phone:612-294-1333
Practice Address - Fax:612-333-6329
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2106363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical