Provider Demographics
NPI:1033307574
Name:MUSTAFA, ESMAT MUFEED (MD)
Entity Type:Individual
Prefix:
First Name:ESMAT
Middle Name:MUFEED
Last Name:MUSTAFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6622 N 91ST AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2569
Mailing Address - Country:US
Mailing Address - Phone:602-759-6883
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:16620 N 40TH ST STE B4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3359
Practice Address - Country:US
Practice Address - Phone:602-559-5770
Practice Address - Fax:602-559-5771
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2018-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ40875207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ353959Medicaid
AZ353959Medicaid
AZZ155880Medicare PIN