Healthcare Provider Details

I. General information

NPI: 1629270608
Provider Name (Legal Business Name): MOHAMMAD AMIN ADIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 10/27/2023
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 S COLUMBIA RD
GRAND FORKS ND
58201-4059
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201-4183
US

V. Phone/Fax

Practice location:
  • Phone: 701-795-2000
  • Fax:
Mailing address:
  • Phone: 701-780-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number15608
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: