Individual
DR. ADAM DONALD AILABOUNI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
UFP - PHALEN VILLAGE CLINIC, 1414 MARYLAND AVENUE EAST, SAINT PAUL, MN 55106
(651) 772-3461
(651) 772-2605
Mailing address
UFP - PHALEN VILLAGE CLINIC, 1414 MARYLAND AVENUE EAST, SAINT PAUL, MN 55106
(651) 772-3461
(651) 772-2605
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
47598
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0597575
—
IA
05
—
496676700
—
MN
01
—
A036
CHAMPUS/TRIWEST
MN
Enumeration date
06/15/2006
Last updated
03/10/2021
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