Provider Demographics
NPI:1841226735
Name:BUSHARA, KHALAFALLA (MB, BS)
Entity Type:Individual
Prefix:DR
First Name:KHALAFALLA
Middle Name:
Last Name:BUSHARA
Suffix:
Gender:M
Credentials:MB, BS
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 295
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-624-6666
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE STREET SE, PWB FIRST FLOOR, CLINIC 1A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN441652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP34287OtherHEALTHPARTNERS
MN1518044OtherARAZ
MN05-00449OtherMEDICA CHOICE
MN1029761OtherPREFERRED ONE
MN397R2BUOtherBCBS
MN141527OtherUCARE
MNHP34287OtherHEALTHPARTNERS