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General NPI Number Information
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NPI Number | 1659746873
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Entity Type | Individual
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Provider Name | MOHAMED OSMAN PRESIDENT
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Gender | Male
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Dates
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Enumeration Date | 12/14/2015
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 7455 FRANCE AVE S SUITE 164
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City | EDINA
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State | MN
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Zip | 55435-4702
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Country | US
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Telephone | 612-886-4450
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Fax |
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Provider Business Mailing Address
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Address Line | 7224 NOBLE AVE N
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-1221
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Country | US
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Telephone | 612-886-4450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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