MEDICARE: BASHIR 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	172A00000X	Driver	M530-0617-9001-06	WI

General Provider Information

NPI Number	:	1487547105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASHIR MOHAMED

Provider Business Mailing Address
First Line	:	2110 W LAYTON AVE APT 138
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53221-2758
Country	:	US
Telephone Number	:	312-483-4043
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 W LAYTON AVE APT 138
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53221-2758
Country	:	US
Telephone Number	:	312-483-4043
Fax Number	:

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

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	06/02/2025

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Directions to “ BASHIR MOHAMED ” Practice Location

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