Basic Information
| Provider Information | |||||||||
| NPI: | 1720063795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AKBAR | ||||||||
| FirstName: | JALAL | ||||||||
| MiddleName: | U | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6465 WAYZATA BLVD | ||||||||
| Address2: | STE 315 | ||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554261728 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2001 N JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754552338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035776000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 03/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 41436 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 41436 | MN | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 438935200 | 05 | MN | MEDICAID |