Provider Demographics
NPI:1497380554
Name:MOHAMED, MOHAMED AMIN
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:AMIN
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 1:3447 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-1018
Mailing Address - Country:US
Mailing Address - Phone:314-662-3637
Mailing Address - Fax:314-800-2314
Practice Address - Street 1:3447 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1018
Practice Address - Country:US
Practice Address - Phone:314-662-3637
Practice Address - Fax:314-800-2314
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health