Individual provider · NPI-1

Mostafa Ghulam Hazrat

Assistant, Podiatric · Grand Blanc, MI

NPI number1194659730
StatusActive
Last updated in NPPESJun 10, 2026

Details

NPI
1194659730
Entity type
Individual (NPI-1)
Name
Mostafa Ghulam Hazrat
Sex
Male
Sole proprietor
Yes
Enumeration date
Jun 10, 2026
Certification date
Jun 10, 2026
Last updated
Jun 10, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
211D00000X Assistant, Podiatric5951001611MIYes

Practice location

1 Genesys Pkwy
Grand Blanc, MI 48439-8065

Phone 810-606-5987

Mailing address

1275 Heatherwood Dr Apt 7450-3b
Grand Blanc, MI 48439-9293

Phone 602-321-2693

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