MEDICARE: JAWAHIR IBRAHIM MOHAMED

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	372500000X	Chore Provider		OH

General Provider Information

NPI Number	:	1275095887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAWAHIR IBRAHIM MOHAMED

Provider Business Mailing Address
First Line	:	3337 WESTERVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-3789
Country	:	US
Telephone Number	:	614-377-0984
Fax Number	:

Provider Business Practice Location Address
First Line	:	3337 WESTERVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-3789
Country	:	US
Telephone Number	:	614-377-0984
Fax Number	:

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

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	05/19/2024

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