Provider Demographics
NPI:1447853247
Name:ABDULLAHI, RIDWAN M
Entity type:Individual
Prefix:
First Name:RIDWAN
Middle Name:M
Last Name:ABDULLAHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 37TH AVE N STE 100
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2005
Mailing Address - Country:US
Mailing Address - Phone:612-666-0447
Mailing Address - Fax:
Practice Address - Street 1:1201 37TH AVE N STE 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2005
Practice Address - Country:US
Practice Address - Phone:612-666-0447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician