Provider Demographics
NPI:1972094951
Name:ALAIWI, ADAM FIRAS
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:FIRAS
Last Name:ALAIWI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ABDULMALEK
Other - Middle Name:FIRAS
Other - Last Name:ALAIWI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4111 CENTRAL AVE NE STE 208A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-2955
Mailing Address - Country:US
Mailing Address - Phone:612-323-2113
Mailing Address - Fax:
Practice Address - Street 1:4111 CENTRAL AVE NE STE 208A
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-2955
Practice Address - Country:US
Practice Address - Phone:612-323-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH498069490621172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty