Provider Demographics
NPI:1710444146
Name:FATAH, ABDI
Entity Type:Individual
Prefix:
First Name:ABDI
Middle Name:
Last Name:FATAH
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 1:7220 YORK AVE S STE 817
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4495
Mailing Address - Country:US
Mailing Address - Phone:612-816-9093
Mailing Address - Fax:612-500-4456
Practice Address - Street 1:7201 YORK AVE S APT 817
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4446
Practice Address - Country:US
Practice Address - Phone:612-816-9090
Practice Address - Fax:612-500-4456
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver