Individual
AHMED JAMA BOTAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
419 CEDAR AVE S APT G278, MINNEAPOLIS, MN 55454-1032
(612) 765-3202
Mailing address
1615 S 4TH ST APT 3510, MINNEAPOLIS, MN 55454-1129
(612) 765-3202
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
03/28/2014
Last updated
03/28/2014
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