Provider Demographics
NPI:1699226829
Name:WARSAME, HIBAQ
Entity Type:Individual
Prefix:
First Name:HIBAQ
Middle Name:
Last Name:WARSAME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 GIRARD AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2020
Mailing Address - Country:US
Mailing Address - Phone:612-636-9197
Mailing Address - Fax:
Practice Address - Street 1:3655 GIRARD AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2020
Practice Address - Country:US
Practice Address - Phone:612-636-9197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization