Healthcare Provider Details

I. General information

NPI: 1063563476
Provider Name (Legal Business Name): YASSER MOHAMED HASSANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21840 23 MILE RD
MACOMB MI
48042-4422
US

IV. Provider business mailing address

21840 23 MILE RD
MACOMB MI
48042-4422
US

V. Phone/Fax

Practice location:
  • Phone: 586-840-4916
  • Fax: 586-591-5929
Mailing address:
  • Phone: 586-840-4916
  • Fax: 586-591-5929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.084012
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301073850
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: