MEDICARE: DR. MUSTAFA AL'ABSI PH. D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	LP4233	MN

General Provider Information

NPI Number	:	1316935224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUSTAFA AL'ABSI PH. D

Provider Business Mailing Address
First Line	:	1035 UNIVERSITY DR
Second Line	:	236, CENTER FOR RURAL MENTAL HEALTH STUDIES, MED.SCHOOL
City	:	DULUTH
State	:	MN
Zip	:	55812-3031
Country	:	US
Telephone Number	:	218-726-7144
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 UNIVERSITY DR
Second Line	:	236, CENTER FOR RURAL MENTAL HEALTH STUDIES, MED.SCHOOL
City	:	DULUTH
State	:	MN
Zip	:	55812-3031
Country	:	US
Telephone Number	:	218-726-7144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/08/2007

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