Provider Demographics
NPI:1902243421
Name:MOHAMED, SHUKRI JAMA
Entity Type:Individual
Prefix:
First Name:SHUKRI
Middle Name:JAMA
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E FRANKLIN AVE S #309
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MINNESOTA
Mailing Address - Zip Code:55404
Mailing Address - Country:UM
Mailing Address - Phone:614-285-9175
Mailing Address - Fax:
Practice Address - Street 1:611 E FRANKLIN AVE APT 309
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2868
Practice Address - Country:US
Practice Address - Phone:614-285-9175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1902243421Medicaid