Provider Demographics
NPI:1316302755
Name:MOHAMED, ABDUL
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:MOHAMED
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 1:2121 NICOLLET AVE
Mailing Address - Street 2:SUITE #203
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2566
Mailing Address - Country:US
Mailing Address - Phone:612-402-9930
Mailing Address - Fax:
Practice Address - Street 1:2121 NICOLLET AVE
Practice Address - Street 2:SUITE #203
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2566
Practice Address - Country:US
Practice Address - Phone:612-402-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)