Provider Demographics
NPI:1164159851
Name:MUHUMED, KHALI MOHAMED
Entity Type:Individual
Prefix:
First Name:KHALI
Middle Name:MOHAMED
Last Name:MUHUMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2696 TROJAN DR APT C5
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-1271
Mailing Address - Country:US
Mailing Address - Phone:920-757-8364
Mailing Address - Fax:
Practice Address - Street 1:2696 TROJAN DR APT C5
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-1271
Practice Address - Country:US
Practice Address - Phone:920-757-8364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver