Healthcare Provider Details

I. General information

NPI: 1457159121
Provider Name (Legal Business Name): ABIB SERENE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 QUEBEC AVE N STE 270C
NEW HOPE MN
55427-1235
US

IV. Provider business mailing address

4124 QUEBEC AVE N STE 270C
NEW HOPE MN
55427-1235
US

V. Phone/Fax

Practice location:
  • Phone: 612-707-2396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IBRAHIM IMAN
Title or Position: OWNER
Credential:
Phone: 612-707-2396