Provider Demographics
NPI:1942992870
Name:ABDI, MOHAMED KHALIF
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:KHALIF
Last Name:ABDI
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 1:320 PARK MEADOWS DR APT 201
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1825
Mailing Address - Country:US
Mailing Address - Phone:651-410-3073
Mailing Address - Fax:
Practice Address - Street 1:8090 EDEN RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5407
Practice Address - Country:US
Practice Address - Phone:651-410-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNG407093183211171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter