Provider Demographics
NPI:1528586906
Name:MOHAMUD, FARHAN (CHW)
Entity Type:Individual
Prefix:
First Name:FARHAN
Middle Name:
Last Name:MOHAMUD
Suffix:
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE W STE 325S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1903
Mailing Address - Country:US
Mailing Address - Phone:888-709-9344
Mailing Address - Fax:
Practice Address - Street 1:2550 UNIVERSITY AVE W STE 325S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1903
Practice Address - Country:US
Practice Address - Phone:888-709-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker