Individual
MR. BASHIR OMAR I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2426 PARK AVE # 309, FARIBAULT, MN 55021
(612) 644-4582
Mailing address
2426 PARK AVE NW APT 309, FARIBAULT, MN 55021-9255
(612) 644-4582
Taxonomy
Speciality
Code
Description
License number
State
171R00000X
Interpreter
Primary
S149126721414
MN
Other
Enumeration date
06/14/2016
Last updated
06/14/2016
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