Healthcare Provider Details

I. General information

NPI: 1598538605
Provider Name (Legal Business Name): MR. BURHAN A SALAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 E 24TH ST # M117
MINNEAPOLIS MN
55404-3869
US

IV. Provider business mailing address

912 E 24TH ST # M117
MINNEAPOLIS MN
55404-3869
US

V. Phone/Fax

Practice location:
  • Phone: 612-423-9597
  • Fax:
Mailing address:
  • Phone: 612-423-9597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: