Provider Demographics
NPI:1568177525
Name:MOHAMED, BONSA YUNUS
Entity Type:Individual
Prefix:
First Name:BONSA
Middle Name:YUNUS
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 1:1728 CLEAR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2224
Mailing Address - Country:US
Mailing Address - Phone:612-481-9857
Mailing Address - Fax:612-250-5255
Practice Address - Street 1:1728 CLEAR AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2224
Practice Address - Country:US
Practice Address - Phone:612-481-9857
Practice Address - Fax:612-250-5255
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)