Provider Demographics
NPI:1770331225
Name:M BASHIR, ABDULLAHI M
Entity type:Individual
Prefix:MR
First Name:ABDULLAHI
Middle Name:M
Last Name:M BASHIR
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 1:1821 UNIVERSITY AVE W STE 294
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2897
Mailing Address - Country:US
Mailing Address - Phone:612-245-5659
Mailing Address - Fax:
Practice Address - Street 1:1821 UNIVERSITY AVE W STE 294
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2897
Practice Address - Country:US
Practice Address - Phone:612-245-5659
Practice Address - Fax:763-205-5617
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA224167200374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide