MEDICARE: MR. BILAL M ALSADI ETC

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	172A00000X	Driver	020602315	MN

General Provider Information

NPI Number	:	1538408265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BILAL M ALSADI ETC

Provider Business Mailing Address
First Line	:	1200 RICE ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-4903
Country	:	US
Telephone Number	:	612-750-4448
Fax Number	:	651-487-0980

Provider Business Practice Location Address
First Line	:	1200 RICE ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-4903
Country	:	US
Telephone Number	:	612-750-4448
Fax Number	:	651-487-0980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2013
Last Update Date	:	01/31/2013

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