MEDICARE: DR. GHULAM MUSTAFA MUGHAL APRN

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
1	363LA2200X	Adult Health Nurse Practitioner	3017741	KY

General Provider Information

NPI Number	:	1205571049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GHULAM MUSTAFA MUGHAL APRN

Provider Business Mailing Address
First Line	:	401 E CHESTNUT ST STE 701
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-5700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E CHESTNUT ST STE 701
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-5700
Country	:	US
Telephone Number	:	502-583-8303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2022
Last Update Date	:	01/21/2026

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