Provider Demographics
NPI:1922814789
Name:OSMAN, MOHAMED AHMED
Entity type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:AHMED
Last Name:OSMAN
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 1:7400 LYNDALE AVE S STE 120
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-4055
Mailing Address - Country:US
Mailing Address - Phone:612-644-4322
Mailing Address - Fax:
Practice Address - Street 1:7400 LYNDALE AVE S STE 120
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-4055
Practice Address - Country:US
Practice Address - Phone:612-644-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver