MEDICARE: ANNUR CLINIC LLC

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	305S00000X	Point of Service

General Provider Information

NPI Number	:	1497193536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNUR CLINIC LLC

Provider Business Mailing Address
First Line	:	1729 LYNDALE AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3349
Country	:	US
Telephone Number	:	612-521-1746
Fax Number	:	612-521-1282

Provider Business Practice Location Address
First Line	:	1729 LYNDALE AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3349
Country	:	US
Telephone Number	:	612-521-1746
Fax Number	:	612-521-1282

Authorized Official
Title or Position	:	IMAM
Name	:	MAKRAM EL-AMIN
Credential	:
Telephone Number	:	612-521-1749

Provider Enumeration Date	:	06/11/2013
Last Update Date	:	06/11/2013

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