Provider Demographics
NPI:1669249231
Name:MOHAMED, MUSTAFA ABDI
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:ABDI
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 1:1821 UNIVERSITY AVE W STE 336
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2876
Mailing Address - Country:US
Mailing Address - Phone:612-886-4781
Mailing Address - Fax:
Practice Address - Street 1:1821 UNIVERSITY AVE W STE 336
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2876
Practice Address - Country:US
Practice Address - Phone:612-886-4781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health