Individual
MOHAMED MOSTAFA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
424 S 56TH ST STE 110, PHOENIX, AZ 85034-2177
(602) 685-5166
Mailing address
PO BOX 42210, PHOENIX, AZ 85080-2210
(623) 266-7770
(414) 805-6980
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
64660
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982011557
—
WI
Enumeration date
07/16/2014
Last updated
05/30/2023
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