Provider Demographics
NPI:1093446635
Name:MOHAMED, ABDIRAHMAN
Entity Type:Individual
Prefix:
First Name:ABDIRAHMAN
Middle Name:
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 1:2614 NICOLLET AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1628
Mailing Address - Country:US
Mailing Address - Phone:612-354-3995
Mailing Address - Fax:
Practice Address - Street 1:1615 S 4TH ST APT M2503
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-3102
Practice Address - Country:US
Practice Address - Phone:612-354-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician