Healthcare Provider Details

I. General information

NPI: 1710700737
Provider Name (Legal Business Name): SALIIM ABDIKADIR ABDULLAHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 PILLSBURY AVE S
BLOOMINGTON MN
55420-2246
US

IV. Provider business mailing address

8500 PILLSBURY AVE S
BLOOMINGTON MN
55420-2246
US

V. Phone/Fax

Practice location:
  • Phone: 612-474-2121
  • Fax: 651-377-4499
Mailing address:
  • Phone: 612-474-2121
  • Fax: 651-377-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: