Healthcare Provider Details

I. General information

NPI: 1003260852
Provider Name (Legal Business Name): AMR IDRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 28TH ST STE 300
MINNEAPOLIS MN
55407-1195
US

IV. Provider business mailing address

3698 BRODY LN
ASHLAND KY
41102-7884
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-1681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number69518
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: