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General NPI Number Information
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NPI Number | 1154115806
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Entity Type | Organization
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Legal Business Name | SIMPLE SPECTRUM SERVICES LLC
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 4445 77TH ST W STE 106B
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City | EDINA
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State | MN
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Zip | 55435-5133
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Country | US
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Telephone | 612-682-2569
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Fax |
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Provider Business Mailing Address
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Address Line | 4445 77TH ST W STE 106B
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City | EDINA
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State | MN
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Zip | 55435-5133
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AHMED KADAR
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Credential |
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Telephone | 612-682-2569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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