Provider Demographics
NPI:1962283721
Name:AHMED, MOHAMED K
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:K
Last Name:AHMED
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 1:925 PAYNE AVE STE B2
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-4280
Mailing Address - Country:US
Mailing Address - Phone:651-802-2533
Mailing Address - Fax:612-288-1002
Practice Address - Street 1:925 PAYNE AVE STE B2
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-4280
Practice Address - Country:US
Practice Address - Phone:651-802-2533
Practice Address - Fax:612-288-1002
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities