Provider Demographics
NPI:1982133674
Name:ALMOAMEN, ALI (MB BCH BAO)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:ALMOAMEN
Suffix:
Gender:M
Credentials:MB BCH BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 SOUTH 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:612-873-6963
Mailing Address - Fax:305-243-8108
Practice Address - Street 1:715 SOUTH 8TH STREET
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-873-6963
Practice Address - Fax:305-243-8108
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2023-08-03
Deactivation Date:2018-01-08
Deactivation Code:
Reactivation Date:2018-01-31
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLTRN25723390200000X
MN729472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program