MEDICARE: MOHAMED OSMAN PRESIDENT

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1659746873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED OSMAN PRESIDENT

Provider Business Mailing Address
First Line	:	7224 NOBLE AVE N
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1221
Country	:	US
Telephone Number	:	612-886-4450
Fax Number	:

Provider Business Practice Location Address
First Line	:	7455 FRANCE AVE S
Second Line	:	SUITE 164
City	:	EDINA
State	:	MN
Zip	:	55435-4702
Country	:	US
Telephone Number	:	612-886-4450
Fax Number	:

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

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	06/14/2016

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Directions to “ MOHAMED OSMAN PRESIDENT” Practice Location

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