Provider Demographics
NPI:1821837212
Name:KAZEEM, PAUL O (LADC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:O
Last Name:KAZEEM
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:821 RAYMOND AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1525
Mailing Address - Country:US
Mailing Address - Phone:651-206-8444
Mailing Address - Fax:
Practice Address - Street 1:287 6TH ST E STE 300
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1690
Practice Address - Country:US
Practice Address - Phone:651-221-0334
Practice Address - Fax:651-221-4449
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306662101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)