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NPI Code Detail

MEDICARE: ABDILADIF BUTHUL

MEDICARE: ABDILADIF BUTHUL
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 : 1578417929
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABDILADIF BUTHUL
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 :
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 : 02/23/2026
Last Update Date : 02/23/2026

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Directions to “ ABDILADIF BUTHUL ” Practice Location

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