MEDICARE: ABDULLAHI MUDEY

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
2	171W00000X	Contractor

General Provider Information

NPI Number	:	1538525894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDULLAHI MUDEY

Provider Business Mailing Address
First Line	:	644 DALE ST N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55103-1643
Country	:	US
Telephone Number	:	612-432-9142
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ANTHONY LN S STE 204
Second Line	:
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-2490
Country	:	US
Telephone Number	:	612-432-9142
Fax Number	:

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

Provider Enumeration Date	:	01/01/2016
Last Update Date	:	03/10/2026

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Directions to “ ABDULLAHI MUDEY ” Practice Location

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