=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811856420
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IDMAN FAUZI AHMED
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2026
-----------------------------------------------------
Last Update Date | 01/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1913 BROADWAY ST NE # 100
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55413-2627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-353-0763
-----------------------------------------------------
Fax | 763-260-9898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 42ND AVE NE APT 405
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55421-3717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-353-0763
-----------------------------------------------------
Fax | 763-260-9898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------