Provider Demographics
NPI:1194778738
Name:MOHAMA, RIYAD (MD)
Entity type:Individual
Prefix:DR
First Name:RIYAD
Middle Name:
Last Name:MOHAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5009
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5009
Mailing Address - Country:US
Mailing Address - Phone:605-977-5000
Mailing Address - Fax:605-977-5377
Practice Address - Street 1:4520 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8148
Practice Address - Country:US
Practice Address - Phone:605-977-5000
Practice Address - Fax:605-977-5377
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3476207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0003382OtherSD BCBS
931451029039OtherPREFERRED ONE
24684OtherHEALTH PARTNERS
165028OtherUCARE
IA53992OtherIA BCBS
MN431200700Medicaid
IA1981787Medicaid
SD6002492Medicaid
SD3476OtherDAKOTACARE
MN4R614MOOtherMN BCBS - PLAN 91057NO
SD6002492Medicaid
24684OtherHEALTH PARTNERS
SDS3382Medicare PIN
IA1981787Medicaid
GA060023143Medicare PIN
MN060000747Medicare PIN