Healthcare Provider Details

I. General information

NPI: 1912861766
Provider Name (Legal Business Name): ADBIRASHID AHMED ALI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 26TH AVE S
MINNEAPOLIS MN
55406-1245
US

IV. Provider business mailing address

2450 26TH AVE S
MINNEAPOLIS MN
55406-1245
US

V. Phone/Fax

Practice location:
  • Phone: 612-256-0888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: