Provider Demographics
NPI:1720465719
Name:WARSAME, MOHAMOUD
Entity Type:Individual
Prefix:
First Name:MOHAMOUD
Middle Name:
Last Name:WARSAME
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 1:2854 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1324
Mailing Address - Country:US
Mailing Address - Phone:612-859-7109
Mailing Address - Fax:612-888-9354
Practice Address - Street 1:2854 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1324
Practice Address - Country:US
Practice Address - Phone:612-859-7109
Practice Address - Fax:612-888-9354
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health