Provider Demographics
NPI:1629719406
Name:HIRSI, SADIQ MAHAMED
Entity Type:Individual
Prefix:
First Name:SADIQ
Middle Name:MAHAMED
Last Name:HIRSI
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 1:4540 SNELLING AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-4313
Mailing Address - Country:US
Mailing Address - Phone:612-205-2030
Mailing Address - Fax:
Practice Address - Street 1:4540 SNELLING AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-4313
Practice Address - Country:US
Practice Address - Phone:612-205-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program