Provider Demographics
NPI:1508631326
Name:MOHAMMED, AHMEDO KAMAL (RESPIRATORY)
Entity Type:Individual
Prefix:
First Name:AHMEDO
Middle Name:KAMAL
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:RESPIRATORY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11178 ABLE ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-5505
Mailing Address - Country:US
Mailing Address - Phone:952-297-7855
Mailing Address - Fax:
Practice Address - Street 1:5015 GARLAND LN N APT A
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-2466
Practice Address - Country:US
Practice Address - Phone:952-297-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician