Provider Demographics
NPI:1215813852
Name:JIBRIL, MOHAMED ABDIFATAH
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ABDIFATAH
Last Name:JIBRIL
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 1:2732 CHICAGO AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3787
Mailing Address - Country:US
Mailing Address - Phone:612-702-0781
Mailing Address - Fax:
Practice Address - Street 1:2732 CHICAGO AVE APT 2
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3787
Practice Address - Country:US
Practice Address - Phone:612-702-0781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNE000-095-119-700172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver