Provider Demographics
NPI:1801619275
Name:JAMA, ILHAAN AHMED
Entity type:Individual
Prefix:
First Name:ILHAAN
Middle Name:AHMED
Last Name:JAMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4088 OAKBROOKE ALCOVE
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-5503
Mailing Address - Country:US
Mailing Address - Phone:763-706-7438
Mailing Address - Fax:
Practice Address - Street 1:4088 OAKBROOKE ALCOVE
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-5503
Practice Address - Country:US
Practice Address - Phone:763-706-7438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNQ727154706916172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver