Provider Demographics
NPI:1730861261
Name:ALI, FOWSI ABDULLAHI
Entity type:Individual
Prefix:
First Name:FOWSI
Middle Name:ABDULLAHI
Last Name:ALI
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 1:2930 146TH ST W APT 152
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-3298
Mailing Address - Country:US
Mailing Address - Phone:952-687-0455
Mailing Address - Fax:
Practice Address - Street 1:7800 METRO PKWY STE 300
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1509
Practice Address - Country:US
Practice Address - Phone:651-322-0152
Practice Address - Fax:952-600-4013
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician