| Ghulam Mustafa Llc | |
|
2401 E Hunt Dr Show Low AZ 85901-7920 | |
| (928) 537-5333 | |
| (928) 537-1762 |
| Full Name | Ghulam Mustafa Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2401 E Hunt Dr, Show Low, Arizona |
| Authorized Official Name and Position | Osaf Ahmed (MEMBER) |
| Authorized Official Contact | 5202693473 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ghulam Mustafa Llc 6989 N Starlight Ridge Pkwy Lakeside AZ 85929-5086 Ph: (520) 269-3473 | Ghulam Mustafa Llc 2401 E Hunt Dr Show Low AZ 85901-7920 Ph: (928) 537-5333 |
| NPI Number | 1477061612 |
|---|---|
| Provider Enumeration Date | 01/22/2018 |
| Last Update Date | 01/22/2018 |
| Medicare PECOS PAC ID | 2062771975 |
|---|---|
| Medicare Enrollment ID | O20180123002037 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477061612 | NPI | - | NPPES |
| 29210 | Other | AZ | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 29210 (Arizona) | Primary |
| Provider Name | Osaf Ahmed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396775680 PECOS PAC ID: 6103739735 Enrollment ID: I20031110000693 |
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