Provider Demographics
NPI:1871338798
Name:OTBAN, MADINA
Entity type:Individual
Prefix:
First Name:MADINA
Middle Name:
Last Name:OTBAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5245 EDINA INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2910
Mailing Address - Country:US
Mailing Address - Phone:952-232-6900
Mailing Address - Fax:952-960-0137
Practice Address - Street 1:5245 EDINA INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2910
Practice Address - Country:US
Practice Address - Phone:952-232-6900
Practice Address - Fax:952-960-0137
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst