Healthcare Provider Details

I. General information

NPI: 1114179991
Provider Name (Legal Business Name): MUSTAFA TEKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 12TH AVE STE 5041 DR. JOHN T. MACDONALD FOUND. DEPT. OF HUMAN GENETICS
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1601 NW 12TH AVE STE 5041 DR. JOHN T. MACDONALD FOUND. DEPT. OF HUMAN GENETICS
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 877-686-6444
  • Fax: 305-243-2396
Mailing address:
  • Phone: 877-686-6444
  • Fax: 305-243-2396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberME 102528
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: