Provider Demographics
NPI:1861118119
Name:MOHAMED, ABDUL
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:MOHAMED
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 1:10604 TUBE DR UNIT 104
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7938
Mailing Address - Country:US
Mailing Address - Phone:214-677-2875
Mailing Address - Fax:
Practice Address - Street 1:10604 TUBE DR UNIT 104
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-7938
Practice Address - Country:US
Practice Address - Phone:214-677-2875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver