Provider Demographics
NPI:1023884103
Name:KASSIM, MUBURAK SIRAJ
Entity type:Individual
Prefix:
First Name:MUBURAK
Middle Name:SIRAJ
Last Name:KASSIM
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 1:4201 99TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1830
Mailing Address - Country:US
Mailing Address - Phone:763-213-5531
Mailing Address - Fax:
Practice Address - Street 1:2625 E FRANKLIN AVE STE LL4
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1195
Practice Address - Country:US
Practice Address - Phone:763-213-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health