=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396714705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FARUK SAID ABUZZAHAB SR. M.D., PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2006
-----------------------------------------------------
Last Update Date | 05/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3601 PARK CENTER BLVD SUITE 207
-----------------------------------------------------
City | ST LOUIS PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55416-2531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-926-3364
-----------------------------------------------------
Fax | 952-926-3369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3601 PARK CENTER BLVD SUITE 207
-----------------------------------------------------
City | ST LOUIS PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55416-2531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-926-3364
-----------------------------------------------------
Fax | 952-926-3369
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 17068
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------