Healthcare Provider Details

I. General information

NPI: 1215316575
Provider Name (Legal Business Name): MOHAMED OMARXEYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 E FRANKLIN AVE STE 209
MINNEAPOLIS MN
55404
US

IV. Provider business mailing address

913 E FRANKLIN AVE STE 209
MINNEAPOLIS MN
55404-2918
US

V. Phone/Fax

Practice location:
  • Phone: 612-462-2841
  • Fax:
Mailing address:
  • Phone: 612-462-2841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number451793594
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: