Provider Demographics
NPI:1518629112
Name:MULAK
Entity Type:Organization
Organization Name:MULAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MUKAILA
Authorized Official - Middle Name:OLADEMIJI
Authorized Official - Last Name:SHODIYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-561-6045
Mailing Address - Street 1:7990 HALIFAX AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2644
Mailing Address - Country:US
Mailing Address - Phone:763-227-6030
Mailing Address - Fax:
Practice Address - Street 1:7990 HALIFAX AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55443-2644
Practice Address - Country:US
Practice Address - Phone:763-227-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty