Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036-148286 | IL |
N | 208600000X | Surgeon | 036-148286 | IL |
N | 208200000X | Surgeon | 4301101895 | MI |
N | 208600000X | Surgeon | 4301101895 | MI |
N | 208200000X | Surgeon | 64641 | CT |
N | 208600000X | Surgeon | 64641 | CT |
Y | 2086S0102X | Surgical Critical Care | 036-148286 | IL |
N | 2086S0102X | Surgical Critical Care | 036148286 | IL |
N | 2086S0102X | Surgical Critical Care | 4301101895 | MI |
N | 2086S0102X | Surgical Critical Care | 64641 | CT |
N | 2086S0102X | Surgical Critical Care | MD048237 | DC |
N | 2086S0102X | Surgical Critical Care | ME146617 | FL |
N | 2086S0127X | Trauma Surgeon | 35.134044 | OH |
N | 2086S0127X | Trauma Surgeon | 64641 | CT |
NPI | 1245261031 |
---|---|
Provider Name | Dr. Gamal Mostafa |
First Address | Chicago, IL 60612-3863 |
Second Address | Chicago, IL 60612-3863 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 17/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
700E012740 | BCBSM GROUP PIN (01) | MI |