Healthcare Provider Details

I. General information

NPI: 1720444276
Provider Name (Legal Business Name): SAID MALIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 PILLSBURY AVE S STE 205
MINNEAPOLIS MN
55408-2275
US

IV. Provider business mailing address

2940 PILLSBURY AVE S #205
MINNEAPOLIS MN
55408
US

V. Phone/Fax

Practice location:
  • Phone: 952-200-7852
  • Fax: 612-234-4409
Mailing address:
  • Phone: 952-200-7852
  • Fax: 612-234-4409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number217149-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: