MEDICARE: DEQA YASSIN MOHAMED M.D

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	207Q00000X	Family Medicine Physician	58637	MN

General Provider Information

NPI Number	:	1780942078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEQA YASSIN MOHAMED M.D

Provider Business Mailing Address
First Line	:	1700 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-3727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2270 FORD PKWY STE 200
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-3412
Country	:	US
Telephone Number	:	651-696-5000
Fax Number	:

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

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	02/06/2024

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