Provider Demographics
NPI:1194508598
Name:AHMED, ABDIRIZAK MOHAMED
Entity type:Individual
Prefix:MR
First Name:ABDIRIZAK
Middle Name:MOHAMED
Last Name:AHMED
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 1:2501 28TH AVE S # 12611
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-9998
Mailing Address - Country:US
Mailing Address - Phone:701-739-5464
Mailing Address - Fax:
Practice Address - Street 1:2501 28TH AVE S # 12611
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-9998
Practice Address - Country:US
Practice Address - Phone:701-739-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle