Healthcare Provider Details

I. General information

NPI: 1528963790
Provider Name (Legal Business Name): MOHAMED MUKHTAR ABDULLE SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 W CLAIREMONT AVE APT 260
EAU CLAIRE WI
54701-6134
US

IV. Provider business mailing address

955 W CLAIREMONT AVE APT 260
EAU CLAIRE WI
54701-6134
US

V. Phone/Fax

Practice location:
  • Phone: 612-998-3278
  • Fax:
Mailing address:
  • Phone: 612-998-3278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: