Doctor Name: | MUSTAFA AL-SABBAGH |
NPI Number: | 1063753291 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | |
Business Practice Address: | 96 Jonathan Lucas St Msc 323 Charleston, SC - 294258900 |
Business Phone Number: | 8437927179 |
Business Fax Number: | 8437929319 |
Mailing Address: | 6130 Village Park Dr, Apt 205 WEST BLOOMFIELD |
State: | MI |
Postal Code: | 483222138 |
Phone Number: | 9736198797 |
Fax Number: | |
NPI Enumeration Date: | 03/13/2013 |
NPI Last Update Date: | 05/31/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |