MEDICARE: HAMDI MOHAMED ISSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		MN

General Provider Information

NPI Number	:	1124752084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAMDI MOHAMED ISSE

Provider Business Mailing Address
First Line	:	4729 GRAND AVE NE
Second Line	:	210
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421
Country	:	US
Telephone Number	:	651-434-9636
Fax Number	:

Provider Business Practice Location Address
First Line	:	4729 GRAND AVE NE APT 210
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-3369
Country	:	US
Telephone Number	:	651-434-9636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	07/14/2022

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Directions to “ HAMDI MOHAMED ISSE ” Practice Location

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