Healthcare Provider Details

I. General information

NPI: 1710828231
Provider Name (Legal Business Name): ABDULAZIZ AHMED ISMAIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 CEDAR AVE S APT 4
MINNEAPOLIS MN
55407-1267
US

IV. Provider business mailing address

2612 CEDAR AVE S APT 4
MINNEAPOLIS MN
55407-1267
US

V. Phone/Fax

Practice location:
  • Phone: 240-471-5391
  • Fax:
Mailing address:
  • Phone: 240-471-5391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: