Healthcare Provider Details

I. General information

NPI: 1477889889
Provider Name (Legal Business Name): SAMER HASSNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 HOLY CROSS PKWY ST. JOSEPH REGIONAL MEDICAL CENTER
MISHAWAKA IN
46545-1469
US

IV. Provider business mailing address

14654 STONINGTON CT
GRANGER IN
46530-8274
US

V. Phone/Fax

Practice location:
  • Phone: 574-335-5000
  • Fax:
Mailing address:
  • Phone: 216-904-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01075142
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2010035691
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01075142A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: