Provider Demographics
NPI:1760287569
Name:MOHAMUD, BASHIR A
Entity type:Individual
Prefix:
First Name:BASHIR
Middle Name:A
Last Name:MOHAMUD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2747
Mailing Address - Country:US
Mailing Address - Phone:651-497-9560
Mailing Address - Fax:
Practice Address - Street 1:1021 E 22ND ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2942
Practice Address - Country:US
Practice Address - Phone:651-497-9560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility