1174511679 NPI number — MR. MOHAMED HASSAN MHS,PT

Table of content: MR. MOHAMED HASSAN MHS,PT (NPI 1174511679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174511679 NPI number — MR. MOHAMED HASSAN MHS,PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASSAN
Provider First Name:
MOHAMED
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MHS,PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174511679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
570 VILLAGE CENTER DR
Provider Second Line Business Mailing Address:
STE 205
Provider Business Mailing Address City Name:
BURR RIDGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60527-4526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-876-7063
Provider Business Mailing Address Fax Number:
630-920-4687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 W 95TH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
EVERGREEN PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-423-7900
Provider Business Practice Location Address Fax Number:
708-423-7999
Provider Enumeration Date:
10/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070007675 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200472150 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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