Provider Demographics
NPI:1457020562
Name:YOUNUS, MOHAMMED MOHAMMED (PA)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:MOHAMMED
Last Name:YOUNUS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:MOHAMMED
Other - Middle Name:
Other - Last Name:YOUNUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4139 JEFFERSON ST NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-2808
Mailing Address - Country:US
Mailing Address - Phone:612-807-8934
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-672-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant