MEDICARE: ABDUL 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	343900000X	Non-emergency Medical Transport (VAN)		MN

General Provider Information

NPI Number	:	1316302755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDUL MOHAMED

Provider Business Mailing Address
First Line	:	2121 NICOLLET AVE
Second Line	:	SUITE #203
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2566
Country	:	US
Telephone Number	:	612-402-9930
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 NICOLLET AVE
Second Line	:	SUITE #203
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2566
Country	:	US
Telephone Number	:	612-402-9930
Fax Number	:

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

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	12/30/2015

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