MEDICARE: MR. MAHAD N ADAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker		MN

General Provider Information

NPI Number	:	1053886705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MAHAD N ADAN

Provider Business Mailing Address
First Line	:	1821 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2433 5TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-3668
Country	:	US
Telephone Number	:	612-323-0197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2018
Last Update Date	:	10/09/2018

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Directions to “ MR. MAHAD N ADAN ” Practice Location

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