Healthcare Provider Details

I. General information

NPI: 1508603291
Provider Name (Legal Business Name): MOSTAFA EL ZARIF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30713 SCHOENHERR RD STE A
WARREN MI
48088-3122
US

IV. Provider business mailing address

30713 SCHOENHERR RD STE A
WARREN MI
48088-3122
US

V. Phone/Fax

Practice location:
  • Phone: 586-284-2643
  • Fax: 586-265-2170
Mailing address:
  • Phone: 586-284-2643
  • Fax: 586-265-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1025352
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number4704425489
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: