MEDICARE: INSPIRE CHANGE CLINIC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1831932128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSPIRE CHANGE CLINIC

Provider Business Mailing Address
First Line	:	2649 PARK AVE # 208
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1006
Country	:	US
Telephone Number	:	612-987-4505
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2813
Country	:	US
Telephone Number	:	612-987-4505
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JAMILA ABDUKADIR
Credential	:	FNP-C
Telephone Number	:	612-987-4505

Provider Enumeration Date	:	06/14/2024
Last Update Date	:	06/14/2024

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Directions to “INSPIRE CHANGE CLINIC ” Practice Location

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