Provider Demographics
NPI:1316938723
Name:MUSTAPHA, JIHAD ALI (MD)
Entity type:Individual
Prefix:DR
First Name:JIHAD
Middle Name:ALI
Last Name:MUSTAPHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1525 E BELTLINE AVE NE STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-4598
Mailing Address - Country:US
Mailing Address - Phone:616-447-8220
Mailing Address - Fax:616-648-2043
Practice Address - Street 1:1525 E BELTLINE AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-4598
Practice Address - Country:US
Practice Address - Phone:616-447-8220
Practice Address - Fax:616-452-6767
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068712207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4719742Medicaid
MI4301068712OtherSTATE LICENSE
MIP00051788OtherRAILROAD MEDICARE
MIG83552Medicare UPIN
MI4719742Medicaid