Provider Demographics
NPI:1871483669
Name:KOSAR, IBRAHIM MUSTAFA
Entity type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:MUSTAFA
Last Name:KOSAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13930 EDGEWOOD AVE UNIT 123
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-1302
Mailing Address - Country:US
Mailing Address - Phone:651-508-0561
Mailing Address - Fax:612-979-2646
Practice Address - Street 1:13930 EDGEWOOD AVE UNIT 123
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-1302
Practice Address - Country:US
Practice Address - Phone:651-508-0561
Practice Address - Fax:612-979-2646
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health