Individual
DR. MUSTAPHA AHMAD EZZEDDINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0356
(336) 716-2255
Mailing address
420 DELAWARE ST SE, MMC 295, MINNEAPOLIS, MN 55455-0341
(612) 625-9900
(612) 625-7950
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
2019-02683
NC
2084N0400X
Neurology Physician
49900
MN
2084V0102X
Vascular Neurology Physician
49900
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0097284
—
NJ
Enumeration date
07/05/2006
Last updated
11/11/2019
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