Organization
GHULAM MUSTAFA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OSAF AHMED MD (MEMBER)
(520) 269-3473
Entity
Organization
Contact information
Practice address
2401 E HUNT DR, SHOW LOW, AZ 85901-7920
(928) 537-5333
(928) 537-1762
Mailing address
6989 N STARLIGHT RIDGE PKWY, LAKESIDE, AZ 85929-5086
(520) 269-3473
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29210
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29210
MEDICAL LICENSE
AZ
Enumeration date
01/22/2018
Last updated
01/22/2018
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