Provider Demographics
NPI:1053927533
Name:AHMED, MOHAMED A
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:A
Last Name:AHMED
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 1:1821 UNIVERSITY AVE W STE 227
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2895
Mailing Address - Country:US
Mailing Address - Phone:612-298-7897
Mailing Address - Fax:
Practice Address - Street 1:1821 UNIVERSITY AVE W STE 227
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2895
Practice Address - Country:US
Practice Address - Phone:612-298-7897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6970345Medicaid
MN85-2775889Medicaid