MEDICARE: MOSTAFA GHULAM HAZRAT

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	211D00000X	Podiatric Assistant	5951001611	MI

General Provider Information

NPI Number	:	1194659730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOSTAFA GHULAM HAZRAT

Provider Business Mailing Address
First Line	:	1275 HEATHERWOOD DR APT 7450-3B
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-9293
Country	:	US
Telephone Number	:	602-321-2693
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GENESYS PKWY
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-8065
Country	:	US
Telephone Number	:	810-606-5987
Fax Number	:

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

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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