Healthcare Provider Details

I. General information

NPI: 1134559735
Provider Name (Legal Business Name): Y HASSANE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 11/18/2013
Certification Date:
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: 586-598-8115
  • Fax: 586-591-5929
Mailing address:
  • Phone: 586-598-8115
  • Fax: 586-591-5929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301073850
License Number StateMI

VIII. Authorized Official

Name: DR. YASSER M HASSANE
Title or Position: OWNER
Credential: M.D.
Phone: 586-840-4916