Provider Demographics
NPI:1700656717
Name:OMAR, MUMIN MOHAMED (NA)
Entity Type:Individual
Prefix:
First Name:MUMIN
Middle Name:MOHAMED
Last Name:OMAR
Suffix:
Gender:M
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 1ST AVE NW APT 201
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3342
Mailing Address - Country:US
Mailing Address - Phone:507-242-6611
Mailing Address - Fax:
Practice Address - Street 1:400 1ST AVE NW APT 201
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3342
Practice Address - Country:US
Practice Address - Phone:507-242-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable