Provider Demographics
NPI:1801881370
Name:RAHIMI, ABDOLLAH
Entity type:Individual
Prefix:DR
First Name:ABDOLLAH
Middle Name:
Last Name:RAHIMI
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 1:15600 36TH AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3369
Mailing Address - Country:US
Mailing Address - Phone:763-559-7688
Mailing Address - Fax:763-559-2237
Practice Address - Street 1:15600 36TH AVE N
Practice Address - Street 2:SUITE 100
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3369
Practice Address - Country:US
Practice Address - Phone:763-559-7688
Practice Address - Fax:763-559-2237
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
MND104651223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN52D14RAOtherBLUE CROSS BLUE SHIELD
MN01006428OtherPREFERRED ONE
MN86-24115OtherMEDICA
MN52D14RAOtherBLUE CROSS BLUE SHIELD