1073768156 NPI number — MR. MUSTAFA HASSAN AHMED

Table of content: MARIA VASCO CUESTA (NPI 1659159416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073768156 NPI number — MR. MUSTAFA HASSAN AHMED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHMED
Provider First Name:
MUSTAFA
Provider Middle Name:
HASSAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073768156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2910 PILLSBURY AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55408-2297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-220-9158
Provider Business Mailing Address Fax Number:
612-824-4487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2910 PILLSBURY AVE S
Provider Second Line Business Practice Location Address:
131
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55408-2297
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-220-9158
Provider Business Practice Location Address Fax Number:
763-412-8913
Provider Enumeration Date:
11/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A143630100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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