Provider Demographics
NPI:1346008091
Name:AHMED, KHALID MOHAMED
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:MOHAMED
Last Name:AHMED
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 1:13176 CORAL SEA CT NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-0019
Mailing Address - Country:US
Mailing Address - Phone:651-703-7408
Mailing Address - Fax:
Practice Address - Street 1:13176 CORAL SEA CT NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-0019
Practice Address - Country:US
Practice Address - Phone:651-703-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker