Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | PENDING | IN |
NPI | 1922285139 |
---|---|
Provider Name | Asim A. Mohammed |
First Address | Fort Wayne, IN 46804-7934 |
Second Address | Fort Wayne, IN 46804-4159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2008 |
Last Update Date | 29/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1922285139 | (05) | WI |