Provider Demographics
NPI:1992415624
Name:MOHAMED, MOHAMED ABDULKADIR
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ABDULKADIR
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 1:825 JUPITER DR APT 101
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-2954
Mailing Address - Country:US
Mailing Address - Phone:608-400-5308
Mailing Address - Fax:
Practice Address - Street 1:825 JUPITER DR APT 101
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-2954
Practice Address - Country:US
Practice Address - Phone:608-400-5308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver