Healthcare Provider Details

I. General information

NPI: 1770319709
Provider Name (Legal Business Name): MOHAMUD ABDULLAHI HUSSEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HIDDEN LAKES PKWY
GOLDEN VALLEY MN
55422-4286
US

IV. Provider business mailing address

88 CESAR CHAVEZ ST APT 342
SAINT PAUL MN
55107-2541
US

V. Phone/Fax

Practice location:
  • Phone: 763-588-2750
  • Fax:
Mailing address:
  • Phone: 612-423-0801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2278G1100X
TaxonomyGeneral Care Certified Respiratory Therapist
License Number5550
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: