Provider Demographics
NPI:1205571049
Name:MUGHAL, GHULAM MUSTAFA (APRN)
Entity type:Individual
Prefix:DR
First Name:GHULAM
Middle Name:MUSTAFA
Last Name:MUGHAL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 S PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2319
Mailing Address - Country:US
Mailing Address - Phone:502-583-1799
Mailing Address - Fax:502-583-1792
Practice Address - Street 1:721 S PRESTON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2319
Practice Address - Country:US
Practice Address - Phone:502-583-1799
Practice Address - Fax:502-583-1792
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017741363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty