Individual
OMER J KISSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6916 91ST TRL N, BROOKLYN PARK, MN 55445-3247
(612) 978-4984
Mailing address
6916 91ST TRL N, BROOKLYN PARK, MN 55445-3247
(612) 978-4984
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
376397
MN
Other
Enumeration date
08/23/2011
Last updated
08/23/2011
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