Healthcare Provider Details

I. General information

NPI: 1407560113
Provider Name (Legal Business Name): ALABASTER HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14348 BURNHAVEN DR
BURNSVILLE MN
55306-4928
US

IV. Provider business mailing address

14348 BURNHAVEN DR
BURNSVILLE MN
55306-4928
US

V. Phone/Fax

Practice location:
  • Phone: 612-345-9900
  • Fax: 612-345-9999
Mailing address:
  • Phone: 612-345-9900
  • Fax: 612-345-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ESEOGHENE ABOKEDE
Title or Position: CEO
Credential: MD
Phone: 612-345-9900