Provider Demographics
NPI:1770453052
Name:ITANI, MUSTAFA MUHAMMED (MD)
Entity type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:MUHAMMED
Last Name:ITANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39049 HYLAND DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2729
Mailing Address - Country:US
Mailing Address - Phone:586-413-6501
Mailing Address - Fax:
Practice Address - Street 1:39049 HYLAND DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2729
Practice Address - Country:US
Practice Address - Phone:586-413-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-11
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189256207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease