MEDICARE: ABDIHAKIN MOHAMUD

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	106S00000X	Behavior Technician		MN

General Provider Information

NPI Number	:	1578255071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDIHAKIN MOHAMUD

Provider Business Mailing Address
First Line	:	3200 SOUTHDALE CIR
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-5162
Country	:	US
Telephone Number	:	614-815-8289
Fax Number	:

Provider Business Practice Location Address
First Line	:	8673 COLUMBINE RD
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7668
Country	:	US
Telephone Number	:	612-964-0142
Fax Number	:

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

Provider Enumeration Date	:	05/23/2023
Last Update Date	:	05/23/2023

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Directions to “ ABDIHAKIN MOHAMUD ” Practice Location

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