Healthcare Provider Details

I. General information

NPI: 1124748736
Provider Name (Legal Business Name): IMRAN DAGANE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 W LAKE ST STE 201
MINNEAPOLIS MN
55408-5170
US

IV. Provider business mailing address

322 W LAKE ST STE 201
MINNEAPOLIS MN
55408-5170
US

V. Phone/Fax

Practice location:
  • Phone: 612-426-0529
  • Fax:
Mailing address:
  • Phone: 612-426-0529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: