Provider Demographics
NPI:1194184218
Name:HASSAN, OMAR MOHAMED
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:MOHAMED
Last Name:HASSAN
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 1:353 ORENDORFF WAY NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-5050
Mailing Address - Country:US
Mailing Address - Phone:612-327-3719
Mailing Address - Fax:612-886-8322
Practice Address - Street 1:353 ORENDORFF WAY NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-5050
Practice Address - Country:US
Practice Address - Phone:612-327-3719
Practice Address - Fax:612-886-8322
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN75147343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)