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General NPI Number Information
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NPI Number | 1871483669
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Entity Type | Individual
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Provider Name | IBRAHIM MUSTAFA KOSAR
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Gender | Male
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 10/19/2025
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Provider Practice Location Address
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Address Line | 13930 EDGEWOOD AVE UNIT 123
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City | SAVAGE
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State | MN
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Zip | 55378-1302
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Country | US
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Telephone | 651-508-0561
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Fax | 612-979-2646
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Provider Business Mailing Address
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Address Line | 13930 EDGEWOOD AVE UNIT 123
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City | SAVAGE
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State | MN
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Zip | 55378-1302
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Country | US
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Telephone | 651-508-0561
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Fax | 612-979-2646
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | MN
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