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General NPI Number Information
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NPI Number | 1104289719
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Entity Type | Organization
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Legal Business Name | HANI ISSE CATERING LLC
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 1900 3RD ST NE 401
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City | MINNEAPOLIS
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State | MN
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Zip | 55418-4349
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Country | US
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Telephone | 612-227-7172
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 3RD ST NE 401
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City | MINNEAPOLIS
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State | MN
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Zip | 55418-4349
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Country | US
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Telephone | 612-227-7172
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HANI MOHAMED ISSE
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Credential |
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Telephone | 612-227-7172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number | A552620000
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License Number State | MN
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