Provider Demographics
NPI:1821817115
Name:WARSAME, ABDIRAHMAN O
Entity type:Individual
Prefix:
First Name:ABDIRAHMAN
Middle Name:O
Last Name:WARSAME
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 1:912 E 24TH ST STE A143
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3874
Mailing Address - Country:US
Mailing Address - Phone:612-290-2500
Mailing Address - Fax:
Practice Address - Street 1:912 E 24TH ST STE A143
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3874
Practice Address - Country:US
Practice Address - Phone:612-290-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNP000-109-946-400172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver