Provider Demographics
NPI:1235218157
Name:MINNESOTA PROFESSIONAL HEALTH SERVICES,INC
Entity Type:Organization
Organization Name:MINNESOTA PROFESSIONAL HEALTH SERVICES,INC
Other - Org Name:MN PROFESSIONAL HEALTH SERVICES,INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDIKARIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-338-5259
Mailing Address - Street 1:810 E FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2834
Mailing Address - Country:US
Mailing Address - Phone:612-338-5259
Mailing Address - Fax:612-338-5269
Practice Address - Street 1:810 E FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2834
Practice Address - Country:US
Practice Address - Phone:612-338-5259
Practice Address - Fax:612-338-5269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN303635900OtherPROVIDER NUMBER