Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1237 | MN |
N | 111NN0400X | Neurology | 153 | MN |
NPI | 1346280781 |
---|---|
Provider Name | Mr. Mahmood Ameli |
First Address | Lakeville, MN 55044 |
Second Address | Lakeville, MN 55044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 15/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127725100 | (05) | MN |
4401618 | MEDICA PROVIDER NUMBER (01) | MN |