Provider Demographics
NPI:1306954516
Name:ELDADAH, MUSTAFA (MD)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:ELDADAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MUSTAFA
Other - Middle Name:
Other - Last Name:EL-DADAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-8611
Mailing Address - Fax:515-643-8812
Practice Address - Street 1:330 LAUREL ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3034
Practice Address - Country:US
Practice Address - Phone:515-643-8611
Practice Address - Fax:515-643-8812
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-33656208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0247742Medicaid
IAI4769Medicare ID - Type Unspecified
IAH51085Medicare UPIN