Provider Demographics
NPI:1700563814
Name:MUHUMED, MOHAMED AHMED
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:AHMED
Last Name:MUHUMED
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:PO BOX 48853
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-0853
Mailing Address - Country:US
Mailing Address - Phone:701-405-2335
Mailing Address - Fax:
Practice Address - Street 1:8665 DUNKIRK CT NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-6790
Practice Address - Country:US
Practice Address - Phone:701-405-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR978129388024343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)