Provider Demographics
NPI:1629845615
Name:HUSSEIN, MOHAMED ABDIKARIM
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ABDIKARIM
Last Name:HUSSEIN
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 1:4720 7TH AVE S STE E
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7254
Mailing Address - Country:US
Mailing Address - Phone:612-458-8011
Mailing Address - Fax:
Practice Address - Street 1:4720 7TH AVE S STE E
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-7254
Practice Address - Country:US
Practice Address - Phone:612-458-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist