Provider Demographics
NPI:1013782770
Name:ABDIALI, ABDIAZIZ HURUSE
Entity Type:Individual
Prefix:
First Name:ABDIAZIZ
Middle Name:HURUSE
Last Name:ABDIALI
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 1:3628 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-2533
Mailing Address - Country:US
Mailing Address - Phone:612-483-8729
Mailing Address - Fax:
Practice Address - Street 1:100 RIVER RIDGE CT
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1613
Practice Address - Country:US
Practice Address - Phone:612-636-8746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist