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NPI Code Detail

MEDICARE: AYUB ALI FARAH

MEDICARE: AYUB ALI FARAH
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 TechnicianMN

General Provider Information

NPI Number : 1457210619
Entity Type Code : Individual
Provider Name (Legal Business Name) : AYUB ALI FARAH
Provider Business Mailing Address
First Line : 2217 GLENWOOD AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55405-1063
Country : US
Telephone Number : 612-208-0729
Fax Number : 612-354-3801
Provider Business Practice Location Address
First Line : 7205 UNIVERSITY AVE NE
Second Line :
City : FRIDLEY
State : MN
Zip : 55432-3134
Country : US
Telephone Number : 612-208-0729
Fax Number : 612-354-3801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2026
Last Update Date : 01/21/2026

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Directions to “ AYUB ALI FARAH ” Practice Location

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