Provider Demographics
NPI:1053013920
Name:FARAH, ABDIRIZAK GELE
Entity type:Individual
Prefix:
First Name:ABDIRIZAK
Middle Name:GELE
Last Name:FARAH
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 1:3822 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-4536
Mailing Address - Country:US
Mailing Address - Phone:414-839-1530
Mailing Address - Fax:
Practice Address - Street 1:3822 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-4536
Practice Address - Country:US
Practice Address - Phone:414-839-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker