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NPI Code Detail

MEDICARE: DR. AVALON F MUSTAFA DCN, RDN CSG, LD/N

MEDICARE: DR. AVALON F MUSTAFA DCN, RDN CSG, LD/N
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian164007129IL

General Provider Information

NPI Number : 1033064290
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AVALON F MUSTAFA DCN, RDN CSG, LD/N
Provider Business Mailing Address
First Line : 1460 HASSELL RD
Second Line :
City : HOFFMAN ESTATES
State : IL
Zip : 60169-2600
Country : US
Telephone Number : 224-444-0125
Fax Number :
Provider Business Practice Location Address
First Line : 1460 HASSELL RD
Second Line :
City : HOFFMAN ESTATES
State : IL
Zip : 60169-2600
Country : US
Telephone Number : 224-444-0125
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2026
Last Update Date : 03/03/2026

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