Provider Demographics
NPI:1255761136
Name:ALI USMANU, RIH-REH
Entity type:Individual
Prefix:
First Name:RIH-REH
Middle Name:
Last Name:ALI USMANU
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 1:7655 61ST ST S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-6004
Mailing Address - Country:US
Mailing Address - Phone:612-236-7979
Mailing Address - Fax:651-714-9213
Practice Address - Street 1:7655 61ST ST S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-6004
Practice Address - Country:US
Practice Address - Phone:612-236-7979
Practice Address - Fax:651-714-9213
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2019-10-18
Deactivation Date:2019-10-09
Deactivation Code:
Reactivation Date:2019-10-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management