Active NPI
Waleed Radwan
- Home Modifications Contractor
- Apple Valley, MN
National Provider Identifier
1407363112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Modifications Contractor
- License
- BC693555
- Practice address
- 14540 Florissant Path
Apple Valley, MN 55124-4535 - Phone
- (612) 708-7586
- NPI assigned
- Jan 3, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | BC693555 | MN | Primary |
Addresses
Primary practice location
14540 Florissant Path
Apple Valley, MN 55124-4535
Mailing address
14540 Florissant Path
Apple Valley, MN 55124-4535
Phone (612) 708-7586
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BC693555 | MN | MD | Home Modifications Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1514937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1514937600000",
"number": "1407363112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14540 FLORISSANT PATH",
"city": "APPLE VALLEY",
"state": "MN",
"postal_code": "551244535",
"telephone_number": "612-708-7586"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14540 FLORISSANT PATH",
"city": "APPLE VALLEY",
"state": "MN",
"postal_code": "551244535",
"telephone_number": "612-708-7586"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADWAN",
"first_name": "WALEED",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-01-03",
"last_updated": "2018-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "171WH0202X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Contractor, Home Modifications",
"state": "MN",
"license": "BC693555",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Apple Valley, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.