Provider Demographics
NPI:1184451437
Name:ALI, ABDOURAHMAN N
Entity type:Individual
Prefix:
First Name:ABDOURAHMAN
Middle Name:N
Last Name:ALI
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 1:11185 ANDERSON LAKES PKWY APT 101
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-4180
Mailing Address - Country:US
Mailing Address - Phone:612-715-5009
Mailing Address - Fax:
Practice Address - Street 1:11185 ANDERSON LAKES PKWY APT 101
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-4180
Practice Address - Country:US
Practice Address - Phone:612-715-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty