Provider Demographics
NPI:1659746873
Name:OSMAN, MOHAMED (PRESIDENT)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:OSMAN
Suffix:
Gender:M
Credentials:PRESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7224 NOBLE AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1221
Mailing Address - Country:US
Mailing Address - Phone:612-886-4450
Mailing Address - Fax:
Practice Address - Street 1:7455 FRANCE AVE S
Practice Address - Street 2:SUITE 164
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4702
Practice Address - Country:US
Practice Address - Phone:612-886-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor