Provider Demographics
NPI:1457381022
Name:MUSTAFA, MUHANAD A (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHANAD
Middle Name:A
Last Name:MUSTAFA
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 1:3000 MEDICAL PARK DRIVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4681
Mailing Address - Country:US
Mailing Address - Phone:813-615-7028
Mailing Address - Fax:813-615-8008
Practice Address - Street 1:3000 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 340
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4681
Practice Address - Country:US
Practice Address - Phone:813-615-7028
Practice Address - Fax:813-615-8008
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87884207RG0100X
FLME115769207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1620YOtherMEDICARE ID
H96358Medicare UPIN
FLAD975Medicare PIN