Provider Demographics
NPI:1497765325
Name:JAMAL, KASSAMALI (MD)
Entity type:Individual
Prefix:DR
First Name:KASSAMALI
Middle Name:
Last Name:JAMAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 13TH AVE E
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3675
Mailing Address - Country:US
Mailing Address - Phone:218-263-7540
Mailing Address - Fax:888-680-4314
Practice Address - Street 1:604 9TH ST N
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2320
Practice Address - Country:US
Practice Address - Phone:218-741-2222
Practice Address - Fax:218-741-7389
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN33Y03KAOtherBCBS
MN810787400Medicaid
MN110136005OtherRR MEDICARE
MN110003960Medicare PIN