Healthcare Provider Details

I. General information

NPI: 1003722752
Provider Name (Legal Business Name): ALI M OSMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6725 YORK AVE S APT 457
EDINA MN
55435-3232
US

IV. Provider business mailing address

6725 YORK AVE S APT 457
EDINA MN
55435-3232
US

V. Phone/Fax

Practice location:
  • Phone: 763-732-8206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5774
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: