Provider Demographics
NPI:1558717603
Name:NAKAWA, MUSTAFA (MBBS)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:NAKAWA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 N 755 W
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-9407
Mailing Address - Country:US
Mailing Address - Phone:617-449-8274
Mailing Address - Fax:
Practice Address - Street 1:8777 BROADWAY STE B
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6694
Practice Address - Country:US
Practice Address - Phone:219-738-5316
Practice Address - Fax:219-738-5708
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01081967A207Q00000X, 207QB0002X
IL036157145207Q00000X, 207QB0002X, 2083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine