Provider Demographics
NPI:1285270017
Name:MAHAMOUD, MAHAMOUD
Entity type:Individual
Prefix:MR
First Name:MAHAMOUD
Middle Name:
Last Name:MAHAMOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DEKO
Other - Middle Name:
Other - Last Name:NIMALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAHAMOUD
Mailing Address - Street 1:708 UNIVERSITY AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2242
Mailing Address - Country:US
Mailing Address - Phone:612-703-6594
Mailing Address - Fax:
Practice Address - Street 1:708 UNIVERSITY AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2242
Practice Address - Country:US
Practice Address - Phone:612-703-6594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter