Provider Demographics
NPI:1265279368
Name:MOHAMED, MOHAMED A
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:A
Last Name:MOHAMED
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 1:12751 COUNTY ROAD 5 STE 109
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2275
Mailing Address - Country:US
Mailing Address - Phone:952-213-9989
Mailing Address - Fax:
Practice Address - Street 1:12751 COUNTY ROAD 5 STE 109
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2275
Practice Address - Country:US
Practice Address - Phone:952-213-9989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician