MEDICARE: DR. MUHANAD A MUSTAFA MD

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	207RG0100X	Gastroenterology Physician	ME87884	FL
2	207RG0100X	Gastroenterology Physician	ME115769	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	U1620Y	OTHER	FL	MEDICARE ID

General Provider Information

NPI Number	:	1457381022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUHANAD A MUSTAFA MD

Provider Business Mailing Address
First Line	:	3000 MEDICAL PARK DRIVE
Second Line	:	SUITE 340
City	:	TAMPA
State	:	FL
Zip	:	33613-4681
Country	:	US
Telephone Number	:	813-615-7028
Fax Number	:	813-615-8008

Provider Business Practice Location Address
First Line	:	3000 MEDICAL PARK DRIVE
Second Line	:	SUITE 340
City	:	TAMPA
State	:	FL
Zip	:	33613-4681
Country	:	US
Telephone Number	:	813-615-7028
Fax Number	:	813-615-8008

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	12/19/2014

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Directions to “ DR. MUHANAD A MUSTAFA MD” Practice Location

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