MEDICARE: MICHEL MOUSSA HANNA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	4301065244	MI

General Provider Information

NPI Number	:	1811994288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHEL MOUSSA HANNA M.D.

Provider Business Mailing Address
First Line	:	5651 BELMONT CIR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-1435
Country	:	US
Telephone Number	:	248-592-9897
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 SOUTH BLVD E
Second Line	:	SUITE 160
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6122
Country	:	US
Telephone Number	:	586-726-0340
Fax Number	:	586-254-3872

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	11/13/2007

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