Provider Demographics
NPI:1902506777
Name:ABDULLE, MAHAD MOHAMED
Entity Type:Individual
Prefix:
First Name:MAHAD
Middle Name:MOHAMED
Last Name:ABDULLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 PARK AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1009
Mailing Address - Country:US
Mailing Address - Phone:763-273-7748
Mailing Address - Fax:
Practice Address - Street 1:2722 PARK AVE STE 204
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1009
Practice Address - Country:US
Practice Address - Phone:763-273-7748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1117849163WH0200X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No163WH0200XNursing Service ProvidersRegistered NurseHome Health