Provider Demographics
NPI:1154818953
Name:MOALLIN, HERSI CABDI
Entity type:Individual
Prefix:DR
First Name:HERSI
Middle Name:CABDI
Last Name:MOALLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HERSI
Other - Middle Name:CABDI
Other - Last Name:MOALLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1000 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2800
Mailing Address - Country:US
Mailing Address - Phone:641-428-7000
Mailing Address - Fax:
Practice Address - Street 1:1631 4TH ST SW STE 114B
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1612
Practice Address - Country:US
Practice Address - Phone:641-428-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75622-20207R00000X
390200000X
IA53868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program