Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0300X | Geriatric Medicine | 102767 | MN |
N | 207RG0300X | Geriatric Medicine | 49263 | MN |
NPI | 1053408500 |
---|---|
Provider Name | Mohammed Yousufuddin |
First Address | Austin, MN 55912-2941 |
Second Address | Austin, MN 55912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 09/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I62485 | (02) |