Provider Demographics
NPI:1538613781
Name:ADAN, RAAHO
Entity type:Individual
Prefix:
First Name:RAAHO
Middle Name:
Last Name:ADAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:IBRAHIM
Other - Middle Name:S
Other - Last Name:SHEIKH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:2240 IDE CT
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2633
Mailing Address - Country:US
Mailing Address - Phone:651-528-6051
Mailing Address - Fax:651-528-6214
Practice Address - Street 1:977 5TH ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106
Practice Address - Country:US
Practice Address - Phone:651-703-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
MN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty