Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 108882 | MN |
N | 207R00000X | Internist | 108882 | MN |
N | 111NI0900X | Internist | 108882 | MN |
NPI | 1134407430 |
---|---|
Provider Name | Eyas Abla |
First Address | Saint Cloud, MN 56303-5000 |
Second Address | Saint Cloud, MN 56303-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2011 |
Last Update Date | 10/05/2016 |