Provider Demographics
NPI:1568204840
Name:JEMAL, MUBAREK KEDIR SR
Entity type:Individual
Prefix:
First Name:MUBAREK
Middle Name:KEDIR
Last Name:JEMAL
Suffix:SR
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 1:2711 EAST TOWER DRIVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238
Mailing Address - Country:US
Mailing Address - Phone:513-739-8278
Mailing Address - Fax:
Practice Address - Street 1:2711 E TOWER DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-6430
Practice Address - Country:US
Practice Address - Phone:513-739-8278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUZ863532343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)