Provider Demographics
NPI:1396976080
Name:MOSTAFA, ASHRAF EHAB (MD)
Entity type:Individual
Prefix:
First Name:ASHRAF
Middle Name:EHAB
Last Name:MOSTAFA
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 1:1257 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1346
Mailing Address - Country:US
Mailing Address - Phone:810-969-4040
Mailing Address - Fax:810-788-7894
Practice Address - Street 1:1257 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1346
Practice Address - Country:US
Practice Address - Phone:810-969-4040
Practice Address - Fax:810-788-7894
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094562207RC0000X, 207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease