Provider Demographics
NPI:1366180242
Name:HUSSEIN, MOHAMED DEK IBRAHIM
Entity type:Individual
Prefix:
First Name:MOHAMED DEK
Middle Name:IBRAHIM
Last Name:HUSSEIN
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 1:1600 BROADWAY ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2617
Mailing Address - Country:US
Mailing Address - Phone:612-412-3318
Mailing Address - Fax:612-288-1805
Practice Address - Street 1:1600 BROADWAY ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2617
Practice Address - Country:US
Practice Address - Phone:612-412-3318
Practice Address - Fax:612-288-1805
Is Sole Proprietor?:No
Enumeration Date:2022-05-22
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst