Provider Demographics
NPI:1245641307
Name:MAWIH, MUSTAFA S (MD)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:S
Last Name:MAWIH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:RM 4003
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1099
Mailing Address - Country:US
Mailing Address - Phone:734-712-3470
Mailing Address - Fax:734-712-2935
Practice Address - Street 1:830 THOMAS MORE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5103
Practice Address - Country:US
Practice Address - Phone:859-341-6281
Practice Address - Fax:859-341-4661
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2021-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301503360207RN0300X
OH35136046207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty