Provider Demographics
NPI:1104287663
Name:ABDILLE, ABDIKARIM
Entity type:Individual
Prefix:
First Name:ABDIKARIM
Middle Name:
Last Name:ABDILLE
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 1:521 LYN PARK CIR N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-3327
Mailing Address - Country:US
Mailing Address - Phone:763-337-9023
Mailing Address - Fax:612-886-2840
Practice Address - Street 1:521 LYN PARK CIR N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411
Practice Address - Country:US
Practice Address - Phone:763-337-9023
Practice Address - Fax:612-886-2840
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications