MEDICARE: HARIS MUJTABA AKHTER BS

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1508502014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARIS MUJTABA AKHTER BS

Provider Business Mailing Address
First Line	:	4163 CASS ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68131-1747
Country	:	US
Telephone Number	:	402-709-9177
Fax Number	:

Provider Business Practice Location Address
First Line	:	668 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-3006
Country	:	US
Telephone Number	:	402-709-9177
Fax Number	:

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

Provider Enumeration Date	:	05/08/2022
Last Update Date	:	04/25/2023

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