Individual
MUBAREK LOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
590 UNIVERSITY AVE W, SAINT PAUL, MN 55103-1939
(612) 245-8906
Mailing address
590 UNIVERSITY AVE W, SAINT PAUL, MN 55103-1939
(612) 245-8906
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
377187
DOT
MN
Enumeration date
12/12/2015
Last updated
12/12/2015
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