Healthcare Provider Details

I. General information

NPI: 1770142929
Provider Name (Legal Business Name): ELIAS N ABDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 PENN AVE S
BLOOMINGTON MN
55431-2320
US

IV. Provider business mailing address

9333 PENN AVE S
BLOOMINGTON MN
55431-2320
US

V. Phone/Fax

Practice location:
  • Phone: 952-393-8233
  • Fax: 952-303-4837
Mailing address:
  • Phone: 952-393-8233
  • Fax: 952-303-4837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: