Provider Demographics
NPI:1154366219
Name:ALIABADI, HOSSEIN A (MD)
Entity type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:A
Last Name:ALIABADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 46100
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-0100
Mailing Address - Country:US
Mailing Address - Phone:763-553-9920
Mailing Address - Fax:
Practice Address - Street 1:2545 CHICAGO AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4522
Practice Address - Country:US
Practice Address - Phone:612-813-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29105208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN857288700Medicaid
MNA96535Medicare UPIN
MN857288700Medicaid