Provider Demographics
NPI:1851847255
Name:MUSTFUL, SAID
Entity Type:Individual
Prefix:
First Name:SAID
Middle Name:
Last Name:MUSTFUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121-0338
Mailing Address - Country:US
Mailing Address - Phone:313-887-5318
Mailing Address - Fax:313-887-5336
Practice Address - Street 1:24818 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1713
Practice Address - Country:US
Practice Address - Phone:313-887-5318
Practice Address - Fax:313-887-5336
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIE0578G172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver