Healthcare Provider Details

I. General information

NPI: 1649105693
Provider Name (Legal Business Name): AKRAM ALTOMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: REKO ALTOMA

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 UNIVERSITY DR S STE 108A
FARGO ND
58103-5348
US

IV. Provider business mailing address

2108 UNIVERSITY DR S STE 108A
FARGO ND
58103-5348
US

V. Phone/Fax

Practice location:
  • Phone: 701-936-0577
  • Fax:
Mailing address:
  • Phone: 701-936-0577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: