MEDICARE: MINNEHAHA MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1508578238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINNEHAHA MEDICAL LLC

Provider Business Mailing Address
First Line	:	962 UNIVERSITY AVE W STE 3
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-4703
Country	:	US
Telephone Number	:	651-666-3972
Fax Number	:

Provider Business Practice Location Address
First Line	:	962 UNIVERSITY AVE W STE 3
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-4703
Country	:	US
Telephone Number	:	651-666-3972
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	FAYSAL WARSAME
Credential	:
Telephone Number	:	763-332-6293

Provider Enumeration Date	:	12/13/2022
Last Update Date	:	07/11/2024

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