Provider Demographics
NPI:1952567513
Name:MUSTAFA, MUHAMMAD R (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:R
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 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-831-2763
Mailing Address - Fax:954-712-3970
Practice Address - Street 1:1625 SE 3RD AVE STE 721
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-831-7263
Practice Address - Fax:954-712-3970
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL268720207RN0300X
NY278103207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME146665OtherFLORIDA MEDICAL LICENSE
FLMZ748OtherMEDICARE ID
NY278103OtherNYS MEDICAL LICENSE
WV3810012858Medicaid