MEDICARE: HABON AHMED

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	172A00000X	Driver		MN

General Provider Information

NPI Number	:	1457001034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HABON AHMED

Provider Business Mailing Address
First Line	:	2817 ANTHONY LN S STE 106
Second Line	:
City	:	SAINT ANTHONY
State	:	MN
Zip	:	55418-2489
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ANTHONY LN S STE 106
Second Line	:
City	:	SAINT ANTHONY
State	:	MN
Zip	:	55418-2489
Country	:	US
Telephone Number	:	651-434-7733
Fax Number	:

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

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	03/25/2022

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Directions to “ HABON AHMED ” Practice Location

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