Provider Demographics
NPI:1902558901
Name:HAJI-YUSUF, MOHAMED A (STS)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:A
Last Name:HAJI-YUSUF
Suffix:
Gender:M
Credentials:STS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 EASTGATE DR SE APT 451
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-6965
Mailing Address - Country:US
Mailing Address - Phone:507-319-1783
Mailing Address - Fax:
Practice Address - Street 1:1217 EASTGATE DR SE APT 451
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-6965
Practice Address - Country:US
Practice Address - Phone:507-319-1783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNP356-188-124-814172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty