Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 108617 | MN |
N | 207Q00000X | Family Doctor | 4301104105 | NY |
Y | 207Q00000X | Family Doctor | 60020 | MN |
NPI | 1003251885 |
---|---|
Provider Name | Mysoon Ayuob |
First Address | St Louis Park, MN 55416-2527 |
Second Address | Faribault, MN 55021-6319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2013 |
Last Update Date | 16/02/2021 |