Provider Demographics
NPI:1912791369
Name:MOHAMED, ILHAM SAFI
Entity type:Individual
Prefix:
First Name:ILHAM
Middle Name:SAFI
Last Name:MOHAMED
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5624 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1606
Mailing Address - Country:US
Mailing Address - Phone:952-395-3322
Mailing Address - Fax:
Practice Address - Street 1:5624 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-1606
Practice Address - Country:US
Practice Address - Phone:952-395-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician