Provider Demographics
NPI:1174625396
Name:MOHAMMED, IMRAN (MD)
Entity type:Individual
Prefix:
First Name:IMRAN
Middle Name:
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 ETHAN WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2296
Mailing Address - Country:US
Mailing Address - Phone:169-679-3513
Mailing Address - Fax:916-679-3563
Practice Address - Street 1:5 MEDICAL PLAZA DR STE 190
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2867
Practice Address - Country:US
Practice Address - Phone:916-679-3590
Practice Address - Fax:916-482-3647
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93443207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500605374Medicaid
OR500605374Medicaid
OR146805Medicare PIN