Provider Demographics
NPI:1295448694
Name:ABDIWAHAB, DAHIR SHARIF
Entity type:Individual
Prefix:
First Name:DAHIR
Middle Name:SHARIF
Last Name:ABDIWAHAB
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 1:778 BERRY ST APT 220
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-0013
Mailing Address - Country:US
Mailing Address - Phone:651-734-3031
Mailing Address - Fax:
Practice Address - Street 1:6260 HIGHWAY 65 NE STE 303
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5150
Practice Address - Country:US
Practice Address - Phone:651-734-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service