Provider Demographics
NPI:1447640453
Name:MIRE, MIRE SHEIKH
Entity type:Individual
Prefix:
First Name:MIRE
Middle Name:SHEIKH
Last Name:MIRE
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 1:2515 S 9TH ST APT 402
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1033
Mailing Address - Country:US
Mailing Address - Phone:612-701-9592
Mailing Address - Fax:
Practice Address - Street 1:2515 S 9TH ST APT 402
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1033
Practice Address - Country:US
Practice Address - Phone:612-701-9592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)