Provider Demographics
NPI:1790584274
Name:MOHAMED, YASIR YUSUF
Entity type:Individual
Prefix:
First Name:YASIR
Middle Name:YUSUF
Last Name:MOHAMED
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 VINE ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-3849
Mailing Address - Country:US
Mailing Address - Phone:920-489-7101
Mailing Address - Fax:
Practice Address - Street 1:2033 VINE ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-3849
Practice Address - Country:US
Practice Address - Phone:920-489-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIMTM343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)