Provider Demographics
NPI:1528012051
Name:GHAZALI, MASOOD RAHEEM (MB, BS)
Entity Type:Individual
Prefix:DR
First Name:MASOOD
Middle Name:RAHEEM
Last Name:GHAZALI
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Gender:M
Credentials:MB, BS
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Mailing Address - Street 1:3833 COON RAPIDS BLVD NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2697
Mailing Address - Country:US
Mailing Address - Phone:763-427-8320
Mailing Address - Fax:763-302-4338
Practice Address - Street 1:3833 COON RAPIDS BLVD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2697
Practice Address - Country:US
Practice Address - Phone:763-427-8320
Practice Address - Fax:763-302-4338
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-05-18
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Provider Licenses
StateLicense IDTaxonomies
IA325992084N0400X
WI488142084N0400X
MN371272084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0500666OtherMEDICA
MN1013385OtherPREFERRED ONE
MN1528012051Medicaid
MNHP21617OtherHEALTHPARTNERS
MN1762066OtherAMERICA'S PPO
WI32343300Medicaid
MNP00228750OtherRAILROAD MEDICARE
MN116880C029OtherUCARE
MN314G7GHOtherBCBS OF MN
MNG44139Medicare UPIN
MN130001208Medicare ID - Type UnspecifiedMEDICARE