Healthcare Provider Details

I. General information

NPI: 1225230204
Provider Name (Legal Business Name): MAHA E ELHASSAN MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2007
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 BEAUBIEN 3RD FLOOR CHM SPECIALTY CTR
DETROIT MI
48201
US

IV. Provider business mailing address

4201 ST. ANTOINE UNIVERSITY PEDIATRICIANS UHC 5D MAILBOX# 226
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-832-9220
  • Fax: 313-993-8977
Mailing address:
  • Phone: 313-966-5051
  • Fax: 313-966-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number4301100143
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: