Individual
DR. MUSTAFA A HASHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15150 FORT ST, SOUTHGATE, MI 48195-1302
(734) 282-4800
(734) 282-9302
Mailing address
15150 FORT ST, SOUTHGATE, MI 48195-1302
(734) 282-4800
(734) 282-5039
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301607758
MI
207RC0000X
Cardiovascular Disease Physician
4301067758
MI
207RI0011X
Interventional Cardiology Physician
Primary
4301067758
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0826155
BLUE CARE NETWORK
MI
01
—
11058553
CAQH
MI
01
—
1699777995
BCBSM IND NPI #
MI
01
—
4301067758
CDS #
MI
05
—
4893450
—
MI
01
—
H75500
HAP
MI
01
—
P00339351
RR MEDICARE
MI
01
—
P34850001
MEDICARE IND PIN #
MI
Enumeration date
06/01/2005
Last updated
03/09/2020
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