Individual
ALI ISACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1041 JAMES AVE N, MINNEAPOLIS, MN 55411-3936
(701) 630-9374
Mailing address
1041 JAMES AVE N, MINNEAPOLIS, MN 55411-3936
(701) 630-9374
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
B992051697320
MN
Other
Enumeration date
10/07/2015
Last updated
10/07/2015
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