Provider Demographics
NPI:1487431763
Name:AYANLE, MOHAMED ABDI
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ABDI
Last Name:AYANLE
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 1:17145 W BLUEMOUND RD STE J311
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5947
Mailing Address - Country:US
Mailing Address - Phone:414-388-6685
Mailing Address - Fax:
Practice Address - Street 1:260 S 5TH ST
Practice Address - Street 2:
Practice Address - City:BARRON
Practice Address - State:WI
Practice Address - Zip Code:54812-1538
Practice Address - Country:US
Practice Address - Phone:414-388-6685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)