Healthcare Provider Details

I. General information

NPI: 1396150306
Provider Name (Legal Business Name): HAMZA MUSTAFA BEANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31157 WOODWARD AVE
ROYAL OAK MI
48073-0996
US

IV. Provider business mailing address

31157 WOODWARD AVE
ROYAL OAK MI
48073-0996
US

V. Phone/Fax

Practice location:
  • Phone: 248-336-1170
  • Fax: 248-336-3190
Mailing address:
  • Phone: 248-336-1170
  • Fax: 248-336-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101269448
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: