Provider Demographics
NPI:1154932507
Name:HABIB, MOHAMUD B
Entity type:Individual
Prefix:
First Name:MOHAMUD
Middle Name:B
Last Name:HABIB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MOHAMUD
Other - Middle Name:BANA
Other - Last Name:HABIB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9400 EARL ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-3741
Mailing Address - Country:US
Mailing Address - Phone:612-402-0211
Mailing Address - Fax:
Practice Address - Street 1:9400 EARL ST
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-3741
Practice Address - Country:US
Practice Address - Phone:612-402-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1166222100027343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)