Provider Demographics
NPI:1720392988
Name:ABAS, MUSTAFA (MD,)
Entity Type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:
Last Name:ABAS
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13221 RAVENNA RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9016
Mailing Address - Country:US
Mailing Address - Phone:440-214-3114
Mailing Address - Fax:
Practice Address - Street 1:13221 RAVENNA RD
Practice Address - Street 2:STE 12
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9047
Practice Address - Country:US
Practice Address - Phone:440-358-5480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-128108207RP1001X
MI4301096084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine