Healthcare Provider Details

I. General information

NPI: 1942481643
Provider Name (Legal Business Name): MUSTAFA HASSAN MAHMOUD HASSAN MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 S LINDEN RD STE A
FLINT MI
48532-3406
US

IV. Provider business mailing address

1165 S LINDEN RD STE A
FLINT MI
48532-3406
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-5400
  • Fax: 810-733-1624
Mailing address:
  • Phone: 810-732-5400
  • Fax: 810-733-1624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301089453
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number4301089453
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 96984
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: