Provider Demographics
NPI:1295302487
Name:ALI, SADIQ MOHAMED
Entity type:Individual
Prefix:MR
First Name:SADIQ
Middle Name:MOHAMED
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 1:14587 GRAND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-5716
Mailing Address - Country:US
Mailing Address - Phone:612-876-7013
Mailing Address - Fax:
Practice Address - Street 1:14587 GRAND AVE STE 110
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-5716
Practice Address - Country:US
Practice Address - Phone:612-876-7013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician