Healthcare Provider Details

I. General information

NPI: 1619504057
Provider Name (Legal Business Name): MANAHIL MUSTAFA ELAMIN MUSTAFA MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5272
US

IV. Provider business mailing address

PO BOX 719094
CHICAGO IL
60677-9318
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-3889
  • Fax: 317-944-3882
Mailing address:
  • Phone: 317-777-6435
  • Fax: 317-777-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number01090425A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: