Provider Demographics
NPI:1932978194
Name:ABDI, JELLE DUBOW
Entity Type:Individual
Prefix:
First Name:JELLE
Middle Name:DUBOW
Last Name:ABDI
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 1:393 DUNLAP ST N STE 450F
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4238
Mailing Address - Country:US
Mailing Address - Phone:651-468-4926
Mailing Address - Fax:
Practice Address - Street 1:393 DUNLAP ST N STE 450F
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4238
Practice Address - Country:US
Practice Address - Phone:651-468-4926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management