Healthcare Provider Details

I. General information

NPI: 1689506495
Provider Name (Legal Business Name): FIZZA HASSAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 WOODS MILL RD STE 201
MANCHESTER MO
63011-3657
US

IV. Provider business mailing address

341 JUANITA MCKEE DR
BALLWIN MO
63011-4349
US

V. Phone/Fax

Practice location:
  • Phone: 636-227-8226
  • Fax:
Mailing address:
  • Phone: 334-233-4643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number2026006646
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: