Provider Demographics
NPI:1134695992
Name:MOHUMED, BURHAN
Entity Type:Individual
Prefix:
First Name:BURHAN
Middle Name:
Last Name:MOHUMED
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 1:5100 EDINA INDUSTRIAL BLVD STE 236
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3066
Mailing Address - Country:US
Mailing Address - Phone:952-303-5803
Mailing Address - Fax:
Practice Address - Street 1:5100 EDINA INDUSTRIAL BLVD STE 236
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-3066
Practice Address - Country:US
Practice Address - Phone:952-303-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health