Provider Demographics
NPI:1780498717
Name:SHURIYE, IBRAHIM OSMAN
Entity type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:OSMAN
Last Name:SHURIYE
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 1:3125 MAINE PRAIRIE RD APT 101
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4790
Mailing Address - Country:US
Mailing Address - Phone:616-856-6609
Mailing Address - Fax:
Practice Address - Street 1:3409 3RD ST N STE 7
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4004
Practice Address - Country:US
Practice Address - Phone:616-856-6609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)