Provider Demographics
NPI:1154091346
Name:ABDULLAHI, MOHAMED AHMED
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:AHMED
Last Name:ABDULLAHI
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 1:4961 S 13TH ST LOWR UNITY
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-3612
Mailing Address - Country:US
Mailing Address - Phone:414-552-5055
Mailing Address - Fax:
Practice Address - Street 1:4961 S 13TH ST LOWR UNITY
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-3612
Practice Address - Country:US
Practice Address - Phone:414-552-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)