Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 35.089607 | OH |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 4301086127 | MI |
NPI | 1215145420 |
---|---|
Provider Name | Hossam Eldin Imam Mustafa |
First Address | Saginaw, MI 48602-4727 |
Second Address | Saginaw, MI 48602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2007 |
Last Update Date | 26/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2760043 | (05) | OH |