Provider Demographics
NPI:1942692033
Name:MOHAMUD, ABDIRIZAK
Entity Type:Individual
Prefix:
First Name:ABDIRIZAK
Middle Name:
Last Name:MOHAMUD
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 1:2932 FLAG AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-2922
Mailing Address - Country:US
Mailing Address - Phone:612-532-6737
Mailing Address - Fax:612-326-1221
Practice Address - Street 1:2932 FLAG AVE S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-2922
Practice Address - Country:US
Practice Address - Phone:612-532-6737
Practice Address - Fax:612-326-1221
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty