MEDICARE: MOHAMMAD MASOUD SALEHI NAMIN

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	2084P0800X	Psychiatry Physician	72454	MN

General Provider Information

NPI Number	:	1386210227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD MASOUD SALEHI NAMIN

Provider Business Mailing Address
First Line	:	2450 RIVERSIDE AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-1450
Country	:	US
Telephone Number	:	612-273-9824
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 RIVERSIDE AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-1450
Country	:	US
Telephone Number	:	612-273-9824
Fax Number	:

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

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	06/12/2026

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