Provider Demographics
NPI:1760724827
Name:ABDIRAHMAN, AHMEDNUR
Entity Type:Individual
Prefix:
First Name:AHMEDNUR
Middle Name:
Last Name:ABDIRAHMAN
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 1:10750 BRUNSWICK RD APT 111
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-1860
Mailing Address - Country:US
Mailing Address - Phone:612-203-6165
Mailing Address - Fax:
Practice Address - Street 1:10750 BRUNSWICK RD APT 111
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1860
Practice Address - Country:US
Practice Address - Phone:612-203-6165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2960569208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2960569OtherHOME HEALTH CARE