Healthcare Provider Details

I. General information

NPI: 1336377043
Provider Name (Legal Business Name): ABDILLAHI ABDINOOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 114TH ST STE 342
CLIVE IA
50325
US

IV. Provider business mailing address

PO BOX 1475
DES MOINES IA
50305-1475
US

V. Phone/Fax

Practice location:
  • Phone: 515-222-7600
  • Fax: 515-222-7601
Mailing address:
  • Phone: 515-222-7600
  • Fax: 515-222-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD-45588
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036.130696
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2012008164
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01076014A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: