Healthcare Provider Details

I. General information

NPI: 1154521342
Provider Name (Legal Business Name): MIKE A ABDULHADI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVE DEPARTMENT OF RADIOLOGY
MINNEAPOLIS MN
55404-4518
US

IV. Provider business mailing address

2525 CHICAGO AVE DEPARTMENT OF RADIOLOGY
MINNEAPOLIS MN
55404-4518
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-6200
  • Fax:
Mailing address:
  • Phone: 612-813-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number55011
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: