Provider Demographics
NPI:1992465843
Name:HABIB, ABDIKARIM ROOSHAN
Entity type:Individual
Prefix:MR
First Name:ABDIKARIM
Middle Name:ROOSHAN
Last Name:HABIB
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 1:7420 BRUNSWICK AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2917
Mailing Address - Country:US
Mailing Address - Phone:612-807-5432
Mailing Address - Fax:
Practice Address - Street 1:7420 BRUNSWICK AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-2917
Practice Address - Country:US
Practice Address - Phone:612-807-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty