Provider Demographics
NPI:1396450953
Name:PRIMEMED PLLC
Entity type:Organization
Organization Name:PRIMEMED PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:857-492-6395
Mailing Address - Street 1:322 W LAKE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3025
Mailing Address - Country:US
Mailing Address - Phone:857-492-6395
Mailing Address - Fax:
Practice Address - Street 1:322 W LAKE ST STE 101
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3025
Practice Address - Country:US
Practice Address - Phone:857-492-6395
Practice Address - Fax:612-465-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care