Provider Demographics
NPI:1437832458
Name:ALBERT, KHADIR T
Entity type:Individual
Prefix:
First Name:KHADIR
Middle Name:T
Last Name:ALBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16419 KISKA ST NE
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-7566
Mailing Address - Country:US
Mailing Address - Phone:952-210-4481
Mailing Address - Fax:
Practice Address - Street 1:400 SELBY AVE STE M
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-4520
Practice Address - Country:US
Practice Address - Phone:952-210-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide