Provider Demographics
NPI:1598525719
Name:MUHUMED, ABDI MOHAMED
Entity Type:Individual
Prefix:
First Name:ABDI
Middle Name:MOHAMED
Last Name:MUHUMED
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 1:2711 CHARLES CT NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8037
Mailing Address - Country:US
Mailing Address - Phone:507-319-1307
Mailing Address - Fax:
Practice Address - Street 1:6113 ROME CIR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-4846
Practice Address - Country:US
Practice Address - Phone:612-202-6124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician