Provider Demographics
NPI:1699521179
Name:OMAR, CAZMI ABDIKANI
Entity type:Individual
Prefix:
First Name:CAZMI
Middle Name:ABDIKANI
Last Name:OMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1330
Mailing Address - Country:US
Mailing Address - Phone:320-342-2031
Mailing Address - Fax:
Practice Address - Street 1:110 DIVISION ST
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1330
Practice Address - Country:US
Practice Address - Phone:132-034-2203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician