Provider Demographics
NPI:1780628461
Name:AILABOUNI, ADAM DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:DONALD
Last Name:AILABOUNI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:UFP - PHALEN VILLAGE CLINIC
Mailing Address - Street 2:1414 MARYLAND AVENUE EAST
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106
Mailing Address - Country:US
Mailing Address - Phone:651-772-3461
Mailing Address - Fax:651-772-2605
Practice Address - Street 1:UFP - PHALEN VILLAGE CLINIC
Practice Address - Street 2:1414 MARYLAND AVENUE EAST
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106
Practice Address - Country:US
Practice Address - Phone:651-772-3461
Practice Address - Fax:651-772-2605
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-03-10
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Provider Licenses
StateLicense IDTaxonomies
MN47598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN496676700Medicaid
MNA036OtherCHAMPUS/TRIWEST
IA0597575Medicaid