Provider Demographics
NPI:1164105763
Name:MOHAMED, ABDELRAHIM (AM)
Entity Type:Individual
Prefix:
First Name:ABDELRAHIM
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:AM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 E REDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8526
Mailing Address - Country:US
Mailing Address - Phone:623-999-4141
Mailing Address - Fax:
Practice Address - Street 1:2909 E REDWOOD LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8526
Practice Address - Country:US
Practice Address - Phone:623-999-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD09031606172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver