Provider Demographics
NPI:1962371633
Name:ERESO, MOHAMED ARARSO (MNDOT 385639)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ARARSO
Last Name:ERESO
Suffix:
Gender:M
Credentials:MNDOT 385639
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 WAYZATA BLVD # 754
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1222
Mailing Address - Country:US
Mailing Address - Phone:763-703-0724
Mailing Address - Fax:
Practice Address - Street 1:5775 WAYZATA BLVD # 754
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1222
Practice Address - Country:US
Practice Address - Phone:763-703-0724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-01
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN385639342000000X
MN76213344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
No344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN394459504Medicaid