Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036.143770 | IL |
Y | 111NI0900X | Internist | 036.143770 | IL |
N | 207RN0300X | Nephrologist | 036.143770 | IL |
N | 207RN0300X | Nephrologist | 55301 | MN |
NPI | 1013203561 |
---|---|
Provider Name | Dr. Abdurrahman M Hamadah |
First Address | Duluth, MN 55802-2207 |
Second Address | Duluth, MN 55802-2207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 12/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |
P01103375 | RAILROAD MEDICARE (01) | MN |