Basic Information
Provider Information
NPI: 1881896223
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABOUFAKHER
FirstName: RABEEA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2401 DEMERS AVE
Address2:  
City: GRAND FORKS
State: ND
PostalCode: 58201
CountryCode: US
TelephoneNumber: 7017801891
FaxNumber: 7017801942
Practice Location
Address1: 1300 S COLUMBIA RD - ALTRU 1300 COLUMBIA
Address2:  
City: GRAND FORKS
State: ND
PostalCode: 852014012
CountryCode: US
TelephoneNumber: 7017802300
FaxNumber: 7017801942
Other Information
ProviderEnumerationDate: 06/05/2007
LastUpdateDate: 12/28/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X4301077144MIN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RG0300X4301077144MIN Allopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
207RC0000X11136NDY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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