MEDICARE: ISMAIL HASSAN MUALIN M.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	207R00000X	Internal Medicine Physician	49433	MN
2	207R00000X	Internal Medicine Physician	A110696	CA

General Provider Information

NPI Number	:	1801012083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISMAIL HASSAN MUALIN M.D

Provider Business Mailing Address
First Line	:	4039 BROOKSIDE AVE
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-2808
Country	:	US
Telephone Number	:	612-473-9392
Fax Number	:

Provider Business Practice Location Address
First Line	:	4039 BROOKSIDE AVE
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-2808
Country	:	US
Telephone Number	:	612-473-9392
Fax Number	:

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	10/07/2025

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