Healthcare Provider Details

I. General information

NPI: 1922911338
Provider Name (Legal Business Name): ABDIRAHMAN MUKHTAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12421 RIVER RIDGE BLVD SUITE B206
BURNSVILLE MN
55337
US

IV. Provider business mailing address

12421 RIVER RIDGE BLVD SUITE B206
BURNSVILLE MN
55337
US

V. Phone/Fax

Practice location:
  • Phone: 952-666-5987
  • Fax:
Mailing address:
  • Phone: 952-666-5987
  • 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: