MEDICARE: MOHAMED MOHAMUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	1207445600025	MN

General Provider Information

NPI Number	:	1487245205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED MOHAMUD

Provider Business Mailing Address
First Line	:	1567 SHERBURNE AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2327
Country	:	US
Telephone Number	:	612-800-2776
Fax Number	:

Provider Business Practice Location Address
First Line	:	1567 SHERBURNE AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2327
Country	:	US
Telephone Number	:	612-800-2776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	02/03/2021

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Directions to “ MOHAMED MOHAMUD ” Practice Location

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