Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 57303 | MN |
NPI | 1295027514 |
---|---|
Provider Name | A B M Masudur Rahman |
First Address | Golden Valley, MN 55422-4840 |
Second Address | Edina, MN 55435-1706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2011 |
Last Update Date | 05/12/2014 |