Healthcare Provider Details

I. General information

NPI: 1184451155
Provider Name (Legal Business Name): MOHAMUD DALLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 INDUSTRIAL MILE RD
COLUMBUS OH
43228-2411
US

IV. Provider business mailing address

464 INDUSTRIAL MILE RD
COLUMBUS OH
43228-2411
US

V. Phone/Fax

Practice location:
  • Phone: 614-332-4655
  • Fax: 614-351-8351
Mailing address:
  • Phone: 614-332-4655
  • Fax: 614-351-8351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: