Healthcare Provider Details

I. General information

NPI: 1093456303
Provider Name (Legal Business Name): ADEL QALIEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W 76TH ST STE 325
EDINA MN
55435-5242
US

IV. Provider business mailing address

3601 W 76TH ST STE 300
EDINA MN
55435-3004
US

V. Phone/Fax

Practice location:
  • Phone: 952-929-1131
  • Fax: 952-929-8873
Mailing address:
  • Phone: 952-929-1131
  • Fax: 952-929-8873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number82103
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: