Active NPI
Idman Fauzi Ahmed
- Addiction (Substance Use Disorder) Counselor
- Minneapolis, MN
National Provider Identifier
1811856420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 1913 Broadway St NE # 100
Minneapolis, MN 55413-2627 - Phone
- (763) 353-0763
- Fax
- (763) 260-9898
- NPI assigned
- Jan 20, 2026
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Primary |
Addresses
Primary practice location
1913 Broadway St NE # 100
Minneapolis, MN 55413-2627
Mailing address
800 42ND Ave NE Apt 405
Minneapolis, MN 55421-3717
Phone (763) 353-0763
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05636163 | Medicaid | MN |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1768867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768867200000",
"number": "1811856420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 42ND AVE NE APT 405",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554213717",
"telephone_number": "763-353-0763",
"fax_number": "763-260-9898"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1913 BROADWAY ST NE # 100",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554132627",
"telephone_number": "763-353-0763",
"fax_number": "763-260-9898"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AHMED",
"first_name": "IDMAN",
"middle_name": "FAUZI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-01-20",
"last_updated": "2026-01-20",
"certification_date": "2026-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "05636163",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.