Provider Demographics
NPI:1528005014
Name:MUSTAFA, AMIRA E (MD)
Entity Type:Individual
Prefix:
First Name:AMIRA
Middle Name:E
Last Name:MUSTAFA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E TURKEYFOOT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-5365
Mailing Address - Country:US
Mailing Address - Phone:330-899-5437
Mailing Address - Fax:330-899-5447
Practice Address - Street 1:1600 E TURKEYFOOT LAKE RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5365
Practice Address - Country:US
Practice Address - Phone:330-899-5437
Practice Address - Fax:330-899-5447
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-088530208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2675378Medicaid