Healthcare Provider Details

I. General information

NPI: 1790516177
Provider Name (Legal Business Name): HESSED HEALTHCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5164 E 81ST AVE STE 298
MERRILLVILLE IN
46410-5852
US

IV. Provider business mailing address

8200 WILSHIRE BLVD
BEVERLY HILLS CA
90211-2328
US

V. Phone/Fax

Practice location:
  • Phone: 310-933-5688
  • Fax: 310-616-5188
Mailing address:
  • Phone: 310-933-5688
  • Fax: 310-616-5188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL FARAH
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 310-933-5688