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NPI Code Detail

MEDICARE: ANISO ALI RAGE

MEDICARE: ANISO ALI RAGE
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1386595957
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANISO ALI RAGE
Provider Business Mailing Address
First Line : 1505 SOUTHCROSS DR W STE 302
Second Line :
City : BURNSVILLE
State : MN
Zip : 55306-7015
Country : US
Telephone Number : 612-427-5204
Fax Number :
Provider Business Practice Location Address
First Line : 1505 SOUTHCROSS DR W STE 302
Second Line :
City : BURNSVILLE
State : MN
Zip : 55306-7015
Country : US
Telephone Number : 612-427-5204
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2026
Last Update Date : 02/09/2026

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Directions to “ ANISO ALI RAGE ” Practice Location

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