Provider Demographics
NPI:1235595430
Name:IDLE, MOHAMED E
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:E
Last Name:IDLE
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 1:2751 HENNEPIN AVE # 110
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1002
Mailing Address - Country:US
Mailing Address - Phone:952-594-0532
Mailing Address - Fax:651-203-7375
Practice Address - Street 1:2751 HENNEPIN AVE # 110
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1002
Practice Address - Country:US
Practice Address - Phone:952-594-0532
Practice Address - Fax:651-203-7375
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)