Ebtihal Ahmed Mohamed Ahmed, MBBS
Individual provider Active NPI Pediatrics Physician · Mankato, MN
NPI 1235653452 · NPPES record last updated Jul 7, 2026
Key facts
- NPI
- 1235653452
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 75936 (MN)
- Practice address
- 1025 Marsh St
Mankato, MN 56001-4752 - Phone
- (507) 625-4031
- NPI assigned
- Jul 29, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Medicare Care Compare profile
- Specialty
- Pediatric Medicine
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
PO Box
Minneapolis, MN 55486
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in NC, MN, WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200512003658 | NC | Practitioner - Pediatric Medicine | 0648601393 | Reassigns benefits to 1 organization |
| I20240122001886 | MN | Practitioner - Pediatric Medicine | 0648601393 | Reassigns benefits to 1 organization |
| I20251028004201 | WI | Practitioner - Pediatric Medicine | 0648601393 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 75936 | MN | MD | Pediatrics Physician |
| 2020-00654 | NC | MD | Pediatrics Physician |
| 103129 | WI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mayo Clinic Health System-Southwest Wisconsin Region, Inc. | Current |
Accepting new patients | |
| Mayo Clinic Health System-Southwest Minnesota Region | Current |
Accepting new patients | |
| Mayo Clinic Health System-Southwest Wisconsin Region, Inc. | Current | Accepting new patients | |
| Mayo Clinic Health System-Southwest Minnesota Region | Current | Accepting new patients | |
| DLP Maria Parham Physician Practices, LLC | Current | Accepting new patients | |
| DLP Maria Parham Physician Practices, LLC | Current |
Accepting new patients | |
| DLP Maria Parham Physician Practices LLC | Current |
Accepting new patients | |
| Mayo Clinic Health System-Southwest Minnesota Region | Current |
Accepting new patients | |
| Mayo Clinic Health System-Southwest Minnesota Region | Past | Accepting new patients |
Locations
1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623
200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850
511 Ruin Creek Rd
Ste 101
Henderson, NC 27536
Phone (252) 436-0440
120 Charles Rollins Rd
Ste 105
Henderson, NC 27536
Phone (252) 438-2773
566 Ruin Creek Rd
Henderson, NC 27536
Phone (252) 436-1352
700 West Ave S
La Crosse, WI 54601
Phone (608) 791-4156
800 E Blackhawk Ave
Prairie du Chien, WI 53821
Phone (608) 326-0808
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Gastroenterology Physician | 2080P0206X | 4301516547 | MI | |
| Pediatrics Physician | 208000000X | 103129 | WI | |
| Pediatrics Physician | 208000000X | 75936 | MN | Yes |
| Pediatrics Physician | 208000000X | 2020-00654 | NC |
Addresses
Primary practice location
1025 Marsh St
Mankato, MN 56001-4752
Mailing address
1500 E Medical Center Dr
Ann Arbor, MI 48109-5000
Phone (734) 936-4717
Other practice location 1
700 West Ave S
La Crosse, WI 54601-8806
Phone (608) 785-0940
Other practice location 2
1500 E Medical Center Dr
Ann Arbor, MI 48109-5000
Phone (734) 936-4717
Other practice location 3
566 Ruin Creek Rd
Henderson, NC 27536-5932
Phone (252) 438-4143
Other providers in Mankato, MN
- Advantage Chiropractic, PLLC
- Affordable & Accessable Van Inc
- Samuel Lawrence Agre
- Janice Ahlers
- Kaitlin Ahlskog
- Hana Mohamed Ahmed
- Kimberly A Aho
- Tricia L. Aiken
- Air Fairies
- Claire Alexander
All providers in Mankato, MN · Pediatrics Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.