Provider Demographics
NPI:1124742457
Name:HUSSEIN, ADNAN ABDILL
Entity type:Individual
Prefix:MR
First Name:ADNAN
Middle Name:ABDILL
Last Name:HUSSEIN
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 1:4008 MINNEHAHA AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3306
Mailing Address - Country:US
Mailing Address - Phone:612-387-6968
Mailing Address - Fax:
Practice Address - Street 1:1066 COUNTY HIGHWAY 10 UNIT 305
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-2664
Practice Address - Country:US
Practice Address - Phone:612-707-6426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCLINICMedicaid