Healthcare Provider Details

I. General information

NPI: 1275488256
Provider Name (Legal Business Name): AHMED BARUT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 LAKELAND DR SE APT 306
WILLMAR MN
56201-3785
US

IV. Provider business mailing address

329 LAKELAND DR SE APT 306
WILLMAR MN
56201-3785
US

V. Phone/Fax

Practice location:
  • Phone: 612-545-8897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: