Healthcare Provider Details

I. General information

NPI: 1306766340
Provider Name (Legal Business Name): ABDULKADIR A YUSUF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7570 147TH ST W STE 125
APPLE VALLEY MN
55124-7574
US

IV. Provider business mailing address

7570 147TH ST W STE 125
APPLE VALLEY MN
55124-7574
US

V. Phone/Fax

Practice location:
  • Phone: 612-772-8031
  • Fax:
Mailing address:
  • Phone: 612-772-8031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: