Provider Demographics
NPI:1174274591
Name:MAHDI, ABDIRAHMAN M
Entity Type:Individual
Prefix:
First Name:ABDIRAHMAN
Middle Name:M
Last Name:MAHDI
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 1:14900 INTERURBAN AVE S STE 290
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-4635
Mailing Address - Country:US
Mailing Address - Phone:206-372-1418
Mailing Address - Fax:
Practice Address - Street 1:14900 INTERURBAN AVE S STE 290
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-4635
Practice Address - Country:US
Practice Address - Phone:206-372-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date: