Provider Demographics
NPI:1376388942
Name:ELMI, MOHAMED ABDI
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ABDI
Last Name:ELMI
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 1:12215 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-1981
Mailing Address - Country:US
Mailing Address - Phone:612-644-7231
Mailing Address - Fax:
Practice Address - Street 1:12215 3RD ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-1981
Practice Address - Country:US
Practice Address - Phone:612-644-7231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN990591748172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker