Healthcare Provider Details

I. General information

NPI: 1639611288
Provider Name (Legal Business Name): KADIR MULLINGS MB.,BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIR
SAINT CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-4907
  • Fax:
Mailing address:
  • Phone: 320-229-4907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number61326
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: