Provider Demographics
NPI:1508644584
Name:SIYAD, TOHOW S
Entity Type:Individual
Prefix:
First Name:TOHOW
Middle Name:S
Last Name:SIYAD
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 1:2917 15TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-5690
Mailing Address - Country:US
Mailing Address - Phone:612-239-1572
Mailing Address - Fax:
Practice Address - Street 1:2917 15TH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-5690
Practice Address - Country:US
Practice Address - Phone:612-239-1572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company