Healthcare Provider Details

I. General information

NPI: 1356256010
Provider Name (Legal Business Name): AYUB ABDIWAHAB ABDULLAHI III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W 62ND ST APT 201
MINNEAPOLIS MN
55419-2345
US

IV. Provider business mailing address

206 W 62ND ST APT 201
MINNEAPOLIS MN
55419-2345
US

V. Phone/Fax

Practice location:
  • Phone: 612-423-4493
  • Fax:
Mailing address:
  • Phone: 612-423-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number424357
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number424357
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number424357
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: