Healthcare Provider Details

I. General information

NPI: 1003816554
Provider Name (Legal Business Name): ALI REZA ARBABI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALIREZA ARBABI M.D.

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 SKYLINE BLVD STE 1
CLOQUET MN
55720-1199
US

IV. Provider business mailing address

10409 GEORGETOWN PL
LAS VEGAS NV
89134-5121
US

V. Phone/Fax

Practice location:
  • Phone: 218-879-4641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53531
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number105170
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11538
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13858
License Number StateND
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMN-53531
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: