MEDICARE: SAIM MUSTAFA DO

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	207R00000X	Internal Medicine Physician	036164321	IL
2	208M00000X	Hospitalist Physician	110806	GA
3	208M00000X	Hospitalist Physician	036164321	IL

General Provider Information

NPI Number	:	1952939308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAIM MUSTAFA DO

Provider Business Mailing Address
First Line	:	4500 MEMORIAL DR
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5360
Country	:	US
Telephone Number	:	618-257-6220
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 MEMORIAL DR
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5360
Country	:	US
Telephone Number	:	618-257-6220
Fax Number	:

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

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	02/20/2026

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Directions to “ SAIM MUSTAFA DO” Practice Location

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