Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 24737 | MN |
N | 111NI0900X | Internist | 24737 | MN |
Y | 207RG0100X | Gastroenterologist | 63187 | MN |
NPI | 1033464888 |
---|---|
Provider Name | Dr. Ahmad Malli |
First Address | Minneapolis, MN 55415-1623 |
Second Address | Minneapolis, MN 55415-1623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2012 |
Last Update Date | 03/05/2018 |