Healthcare Provider Details

I. General information

NPI: 1881536662
Provider Name (Legal Business Name): ABDULLAHI ABDIQANI AWALE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 17TH ST SW
WILLMAR MN
56201-2836
US

IV. Provider business mailing address

808 17TH ST SW
WILLMAR MN
56201-2836
US

V. Phone/Fax

Practice location:
  • Phone: 320-493-7032
  • Fax:
Mailing address:
  • Phone: 320-493-7032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberR528119788515
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: