Provider Demographics
NPI:1417653403
Name:MOHAMED, ABDIKHALIQ ANWAR
Entity Type:Individual
Prefix:
First Name:ABDIKHALIQ
Middle Name:ANWAR
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 1:2811 15TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1425
Mailing Address - Country:US
Mailing Address - Phone:651-500-9096
Mailing Address - Fax:
Practice Address - Street 1:6260 HIGHWAY 65 NE STE 303
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55432-5150
Practice Address - Country:US
Practice Address - Phone:614-218-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst