MEDICARE: DR. HASSAN MAJED MOSTAFA 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	207RC0000X	Cardiovascular Disease Physician	01077342A	IN
2	390200000X	Student in an Organized Health Care Education/Training Program	11018018A	IN
3	207RC0000X	Cardiovascular Disease Physician	4301506086	MI

General Provider Information

NPI Number	:	1174939003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HASSAN MAJED MOSTAFA M.D.

Provider Business Mailing Address
First Line	:	1 FORD PL STE 2E
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3450
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 PAGE AVE STE B
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-2462
Country	:	US
Telephone Number	:	517-205-4800
Fax Number	:

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

Provider Enumeration Date	:	07/11/2014
Last Update Date	:	04/08/2022

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