Healthcare Provider Details

I. General information

NPI: 1023938396
Provider Name (Legal Business Name): HANAN MOHAMED OMAR ALFEGGI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 09/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST.
DETROIT MI
48201
US

IV. Provider business mailing address

150 ALICE AVE.
BROOMFIELD TOWNSHIP MI
48302
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-8736
  • Fax: 313-745-8645
Mailing address:
  • Phone: 947-280-0076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: