Provider Demographics
NPI:1992566798
Name:MOHAMED, MUHUMED ISMAIL
Entity type:Individual
Prefix:
First Name:MUHUMED
Middle Name:ISMAIL
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 1:2748 E 82ND ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1365
Mailing Address - Country:US
Mailing Address - Phone:612-505-3700
Mailing Address - Fax:
Practice Address - Street 1:2748 E 82ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1365
Practice Address - Country:US
Practice Address - Phone:612-505-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst