MEDICARE: SOUTH MINNEAPOLIS WALK-IN 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	261QU0200X	Urgent Care Clinic/Center	1932	MN

General Provider Information

NPI Number	:	1730582156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH MINNEAPOLIS WALK-IN CLINIC LLC

Provider Business Mailing Address
First Line	:	4727 HIAWATHA AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406
Country	:	US
Telephone Number	:	612-205-9326
Fax Number	:

Provider Business Practice Location Address
First Line	:	4727 HIAWATHA AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-3928
Country	:	US
Telephone Number	:	612-205-9326
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ABDULLAHI ABDI HUSSEIN
Credential	:	PA-C
Telephone Number	:	612-205-9326

Provider Enumeration Date	:	09/30/2014
Last Update Date	:	05/28/2015

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