Provider Demographics
NPI:1952089872
Name:ADAN, ABDIQADIR A
Entity Type:Individual
Prefix:
First Name:ABDIQADIR
Middle Name:A
Last Name:ADAN
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 1:541 W LAPHAM BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3419
Mailing Address - Country:US
Mailing Address - Phone:414-213-0698
Mailing Address - Fax:
Practice Address - Street 1:541 W LAPHAM BLVD APT 102
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3419
Practice Address - Country:US
Practice Address - Phone:414-213-0698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)