Provider Demographics
NPI:1740393537
Name:HARES, MUSTAFA ABDUL-KARIM (MD)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:ABDUL-KARIM
Last Name:HARES
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 1:3252 UNIVERSITY DR
Mailing Address - Street 2:STE 140
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2782
Mailing Address - Country:US
Mailing Address - Phone:248-371-3199
Mailing Address - Fax:248-371-1930
Practice Address - Street 1:3252 UNIVERSITY DR
Practice Address - Street 2:STE 140
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2782
Practice Address - Country:US
Practice Address - Phone:248-371-3199
Practice Address - Fax:248-371-1930
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040359208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2805270Medicaid
MI2805270Medicaid
0630847Medicare ID - Type Unspecified