Provider Demographics
NPI:1982337358
Name:MOHAMMED, MOHAMMED ADEL (CCP, LP, MPS)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:ADEL
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:CCP, LP, MPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2773
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47131-2773
Mailing Address - Country:US
Mailing Address - Phone:812-736-2211
Mailing Address - Fax:877-455-1021
Practice Address - Street 1:959 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1639
Practice Address - Country:US
Practice Address - Phone:877-234-3266
Practice Address - Fax:877-455-1021
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI214242T00000X
TXFPF02000199242T00000X
PAPRF000451242T00000X
MO2019027175242T00000X
IL214000415242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist