Provider Demographics
NPI:1376313056
Name:MOHAMED, JIMALE ABDI
Entity Type:Individual
Prefix:
First Name:JIMALE
Middle Name:ABDI
Last Name:MOHAMED
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 1:3909 HERITAGE HILLS DR APT 202
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-2628
Mailing Address - Country:US
Mailing Address - Phone:763-331-2274
Mailing Address - Fax:
Practice Address - Street 1:393 DUNLAP ST N STE 870
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4204
Practice Address - Country:US
Practice Address - Phone:763-331-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health