Provider Demographics
NPI:1437468337
Name:HAREED, MOHAMED S
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:S
Last Name:HAREED
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 1:922 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3829
Mailing Address - Country:US
Mailing Address - Phone:317-835-3720
Mailing Address - Fax:
Practice Address - Street 1:922 E 24TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3829
Practice Address - Country:US
Practice Address - Phone:317-835-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X, 305R00000X
MN3925502-2374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No251J00000XAgenciesNursing Care
No374U00000XNursing Service Related ProvidersHome Health Aide