Provider Demographics
NPI:1659050029
Name:MOHAMED, ABDIKARIM IBRAHIM I
Entity Type:Individual
Prefix:MR
First Name:ABDIKARIM
Middle Name:IBRAHIM
Last Name:MOHAMED
Suffix:I
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 1:1945 SACHTJEN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3335
Mailing Address - Country:US
Mailing Address - Phone:612-447-7022
Mailing Address - Fax:
Practice Address - Street 1:1945 SACHTJEN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3335
Practice Address - Country:US
Practice Address - Phone:612-447-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty