Basic Information
| Provider Information | |||||||||
| NPI: | 1306954516 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELDADAH | ||||||||
| FirstName: | MUSTAFA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | EL-DADAH | ||||||||
| OtherFirstName: | MUSTAFA | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1475 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503051475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5156438611 | ||||||||
| FaxNumber: | 5156438812 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 LAUREL ST | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503143034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5156438611 | ||||||||
| FaxNumber: | 5156438812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 01/18/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD-33656 | IA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.