Healthcare Provider Details

I. General information

NPI: 1568227007
Provider Name (Legal Business Name): AHMEDNOOR IBRAHIM YEROW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 N CONCORD ST S 327
SAINT PAUL MN
55075
US

IV. Provider business mailing address

1185 N CONCORD ST S 327
SAINT PAUL MN
55075
US

V. Phone/Fax

Practice location:
  • Phone: 720-771-1294
  • Fax:
Mailing address:
  • Phone: 720-771-1294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberG000068561100
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: