Healthcare Provider Details

I. General information

NPI: 1376779900
Provider Name (Legal Business Name): MUSTAFA KENDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 BROADWAY AVE S APT 619
ROCHESTER MN
55904-6977
US

IV. Provider business mailing address

425 BROADWAY AVE S APT 619
ROCHESTER MN
55904-6977
US

V. Phone/Fax

Practice location:
  • Phone: 218-565-6200
  • Fax: 651-431-7697
Mailing address:
  • Phone: 218-565-6200
  • Fax: 651-431-7697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number51961
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: