Healthcare Provider Details

I. General information

NPI: 1902777089
Provider Name (Legal Business Name): ALI ABDI DAHIR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15815 FRANKLIN TRL SE STE 502
PRIOR LAKE MN
55372-2076
US

IV. Provider business mailing address

460 5TH AVE N APT 433
HOPKINS MN
55343-7261
US

V. Phone/Fax

Practice location:
  • Phone: 507-202-3707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberVG568043
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: