Provider Demographics
NPI:1982462891
Name:AFRAH, ABDIFATAH
Entity Type:Individual
Prefix:
First Name:ABDIFATAH
Middle Name:
Last Name:AFRAH
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 1:3373 W SAINT GERMAIN ST APT 243
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-3733
Mailing Address - Country:US
Mailing Address - Phone:207-344-5424
Mailing Address - Fax:
Practice Address - Street 1:3373 W SAINT GERMAIN ST APT 243
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3733
Practice Address - Country:US
Practice Address - Phone:207-344-5424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor