Provider Demographics
NPI:1811923659
Name:YASSIN, MOHAMED SATTI (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:SATTI
Last Name:YASSIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1511 NORTHWAY DRIVE SUITE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-654-8266
Mailing Address - Fax:320-654-8481
Practice Address - Street 1:1511 NORTHWAY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1261
Practice Address - Country:US
Practice Address - Phone:320-654-8266
Practice Address - Fax:320-654-8481
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32468174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNB48640Medicare UPIN