1023949757 NPI number — ABDOULKADER AL

Table of content: ABDOULKADER AL (NPI 1023949757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023949757 NPI number — ABDOULKADER AL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AL
Provider First Name:
ABDOULKADER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023949757
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 BLAKE RD N APT 512
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPKINS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55343-8254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 MARIE AVE E STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55118-5950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-315-2321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Z000120005200 . This is a "STATE ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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