Provider Demographics
NPI:1780202895
Name:HUSSEN, MOHAMED IBRAHIM
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:IBRAHIM
Last Name:HUSSEN
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 1:2901 MOUNDS VIEW BLVD APT 114
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-0009
Mailing Address - Country:US
Mailing Address - Phone:763-639-6754
Mailing Address - Fax:
Practice Address - Street 1:2901 MOUNDS VIEW BLVD APT 114
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-0009
Practice Address - Country:US
Practice Address - Phone:763-639-6754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health