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General NPI Number Information
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NPI Number | 1043479876
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Entity Type | Individual
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Provider Name | NABEEL BISHARA AILABOUNI DO
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Gender | Male
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 16830 198TH AVE NW BIG LAKE CLINIC
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City | BIG LAKE
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State | MN
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Zip | 55309
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Country | US
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Telephone | 763-263-7300
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Fax | 763-263-7334
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Provider Business Mailing Address
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Address Line | 16830 198TH AVE NW BIG LAKE CLINIC
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City | BIG LAKE
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State | MN
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Zip | 55309
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Country | US
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Telephone | 763-263-7300
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Fax | 763-263-7334
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 105377
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License Number State | MN
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