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General NPI Number Information
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NPI Number | 1114554458
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Entity Type | Individual
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Provider Name | MUHAREB MUSTAFA MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 743 SPRING ST NE STE 710
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City | GAINESVILLE
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State | GA
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Zip | 30501-3715
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Country | US
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Telephone | 770-219-8730
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 S CANTON CENTER RD STE 200
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City | CANTON
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State | MI
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Zip | 48188-6276
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Country | US
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Telephone | 734-398-7880
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301509740
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License Number State | MI
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