Healthcare Provider Details

I. General information

NPI: 1669532065
Provider Name (Legal Business Name): AHMED A. HASSAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8960 COLONIAL CENTER DR SUITE 206
FORT MYERS FL
33905-7809
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9560
  • Fax: 239-343-9624
Mailing address:
  • Phone: 239-424-1449
  • Fax: 239-424-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number4301032214
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME0030650
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: